
Class 
Book 



COPYRIGHT DEPOSIT 



\ 




Lungs. 



VENUS OF MILO. 
-, Heart. , Stomach. 



Liver. 



DOMESTIC HANDBOOK 



OF THE 



DISEASES OF WOMEN 



AND OF 



MIDAVIFEEY, 



WITH SUPPLEMENTARY CHAPTERS. 

/- 

G7 R. SOUTH WICK, M. D., 

associate professor of obstetrics ix the bostox university school, of 
medicixe; l. m., rotunda hospitals, Dublin; ex-clinical assistaxt ix 
the rotunda hospitals and royal lying-in hospital, dresden; ex- 
member of the uxiversity of viexxa ; ex-presidext of the bostox 
hom<eopathic medical society; ex-presidext of the massachu- 
setts surgical axd gynecological society"; member of the 
massachusetts homoeopathic medical society axd of 
the americax institute of homoeopathy; hoxorary 
member of the missouri institute of home- 
opathy ; gynecologist to the boston 

HOMOEOPATHIC DISPENSARY. 

AUTHOR OF "A PRACTICAL MANUAL OF GYNECOLOGY"; "A GYNECOLOGICAL CASE 
BOOK FOR PHYSICIAXS"; AXD "THE HYGIEXE OF THE SEXES." 







BOSTON : 

Hygienic Publishing ( o. 

1882. 



r 






IX 









ENTERED ACCORDING TO \< I <" < ONGRJ 88, IN THE YEAR 18 
(.. i;. 80UTHWICK, M. D., 
In the Office 01 phe Librarian of Congress at 
washington, i). c., t. b. a. 






COLLINS PRESS: BOSTON. 



PREFACE 



The domestic treatment of the Diseases of Women and 
Midwifery is naturally confined within somewhat narrow limits. 
There are few, if any, women who are not better physically for 
a knowledge of diseases and conditions peculiar to their sex. 
They know better how to care for themselves, to prevent dis- 
eases, to recognize dangerous conditions while they are still 
curable, and thus to save themselves from much pain and 
suffering. Many women live where competent physicians can- 
not be procured, and reliable information concerning their 
troubles means health and even life itself. 

The illustrations in this book have been prepared with great 
care by experts to insure clearness and accuracy, and the de- 
scriptions are plain and practical. 

Some of them have been adapted from those in the writings 
of such distinguished authors as Tarnier, Schultze, Skene, Lud- 
lam, Heitzman, Reibmayr, and Coe. 

The publishers of " Babyhood " have kindly allowed the use 
of illustrations on pages 230, 232, 241, and 249. 

A chapter on Sexual Hygiene has been bound separately 
for obvious reasons. 

There have been many inquiries among m} T patients for a 
reliable domestic work of this kind, and the author presents this 
book to the public with the hope that it will fill a long-felt 
want, and meet with hearty approval. 

G. R. SOUTHWTCK, M. D. 
Boston, Mass., 
460 West Chester Park. 
July 1, 1892. 



TABLE OF CONTENTS. 



PART I. 

A Domestic Handbook of the Diseases of Women. 



CHAPTER I. 

PAGE 

Introduction 9-23 

Value and Selection of the Symptoms of Disease. — Constitutional 
Symptoms. — Prescribing by Symptoms. — Medicine vermis Surgery 
in treating the Diseases of Women. — Distinguishing most 
Important Symptoms and Remedies. — Frequency of giving 
Medicine. — Disks, Pills, Powders, Tablets, Liquids, Doses. — 
Preparation of Medicine in Water. — Consultation by Mail. — 
Selection of a Physician. — Purchasing of Instruments and Medi- 
cines. 

CHAPTER II. 

The Anatomy of the Female Pelvic Organs .... 24-29 

Vulva, Labia, Lips, Urethra, Anus, Rectum, Piles; Pelvis, True, False, 
Deformed; Vagina, Perineum, Uterus, Cervix Uteri, Bladder, Peri- 
toneum, Ovaries, Fallopian Tubes. — The Ovum. 

CHAPTER III. 
The Causes of Gynecological Diseases 30-40 

Health of American Women. — Habits at Puberty. — Fashion, Bodily 
Posture, Education, Society. — Causes of Disease after Marriage — 
Marriage and Childbearing. — Marriage and Existing Uterine 
Disease, as Tumors, Cancer, Consumption, and Insanity. — Mar- 
riage of Near Relatives. — Conditions of Disease requiring an 
Examination. 

CHAPTER IV. 
Puberty and the Climacteric Period 41-72 

Puberty, Menstruation. — The Climacteric Period. — Hygiene of Pu- 
berty and the Climacteric. — The Hot Water Vaginal Douche.— 
Medicated Douches.— Sitz Baths. — Foot Baths.— The First Men- 
strual Period. — Chlorosis. — Green Sickness or so-called Consump- 
tion of the Blood.— Treatment. — Menstrual Headaches and their 
Treatment. — Menstrual Toothache and its Treatment. — Toothache 
during Pregnancy and its Treatment. — Loss of Voice during 
Menstruation. — Deafness during Menstruation. —Peculiarities of 
the Change of Life. — Treatment of Symptoms peculiar to the 
Change of Life. 



VI 



CONTEXTS. 



CHAPTER V. 
Pruritus Vulvje, or Itching of the Genitals . . . . 

Itching of tlie Genitals. — Pediculus Pubis or Crab Louse.— Pin- 
worms.— Eczema oi' the Vulva.— Local Application and Treat- 
ment. 



73-77 



CHAPTER VI. 

Laceration op the Perineum. — Cystocele. — Recto- 
cele. — absces8 ob bollfl ix the external genitals, 
Causes of Laceration.— Parts Involved.— Consequences of the Lacer- 
atlon.— Formation of Cystocele and Rectocele. — Consequent 
them. — How to tell when an Operation is necessary. — Aba 
and Roils, how to tell and how to treat them. 



78-81 



CHAPTER VII. 



Vulvitis, Vaginitis 

Simple Inflammation. — Virulent or Gonorrhoea! Inflammation.— 
Clap. — Treatment. — Local Treatment and Remedies.— Warts.— 
Syphilis. 






CHAPTER VIII. 
Vaginismus. — Atresia.— Fistula 

Vaginismus. — < lauses. — Treatment. — Imperforate Hymen. — ina- 
bility for Monthly Flow to escape.— Atresia. — it- Forms, Causes, 
and Treatment.— Fistulas. —Causes and Treatment. 



89-93 



CHAPTER IX. 

Amenorrhea (Absence <>f the Monthly Flows. . . . 
Absence of the Monthly Flow, when Natural and Unnatural.— 4 auses 
for Failure of Menses to appear. — A Sign of Consumption.— 
Prevalence of Amenorrheas among College Girls. — Relation to 
the General Health.— Diet, Hygiene, General and Medical Treat- 
ment. 



! (4-103 



CHAPTER X. 
Menorrhagia and Metrorrhagia (Excessive Flowing 

Excessive Flowing. — Causes, Relation to Tumors. Abortion, etc.— 

Diet. — General and Medical Treatment. — Vicarious Menstruation 
or the Periodical Loss of Blood from other Places than the Genital 
Organs. — Medical Treatment. 



104-113 



CHAPTER XI. 
or Painful Menstruation 114-124 



Dysmenorrhea 

Causes.— Forms.— Membranous Dysmenorrhea. — Relation to Pre 

nancy. — Strain in Early Womanhood. — Effect of Childbearing. 



Effect of Marriage. — Hot Foot Bath. — Hot Applications. - 

tricity. — Remedies to cure Painful Menstruation. 



Flee- 






CONTENTS. Vll 

CHAPTER XII. 

PAGE 

Displacement of the Sexual Organs 125-1 4S 

Posterior Displacements of the Uterus. — Symptoms, Bearing Down, 
Backache, Headache, Inability to walk, Frequent Urination. — 
Retroflection, Retroversion, Causes.— Prolapsus Uteri, Falling 
of the Womb. — Anteversion and Anteflexion of the Uterus. — 
Treatment of Uterine Displacements, Douches, Supporters, Pessa- 
ries.— Posture for replacing the Uterus.— Displacement of the 
Uterus and Ovaries with Adhesions.— Swedish Gymnasium Cure- 
Probability of Cure. — Medicines. 



CHAPTER XIII. 

Leucorrhoea or Whites 149-157 

Causes of Leucorrhoea or Whites. — Ulceration or Erosion of the Cer- 
vix Uteri. — Inflammation of the Endometrium. — Leucorrhcea in 
Little Girls and its Causes. — Gonorrhoea. — The German Cure. — 
Hygiene. — Local and Medical Treatment. 



CHAPTER XIV. 
Inflammation of the Uterus and Surrounding Tissues, 15S-16; 

Causes of Metritis. — Pelvic Peritonitis and Pelvic Cellulitis. — Acute 
and Chronic Stages. — Relation to Cold Water Injections, Abortion, 
and Childbed Fever. — Symptoms.— General and Medical Treat- 
ment. 



CHAPTER XV. 
Inflammation and Neuralgia of the Ovaries .... 168-17! 

Forms and Causes of Ovaritis; Results, Symptoms, Effect on the Ner- 
vous System. — Local and General Treatment. — Medicines. — 
Ovarian Neuralgia. — Causes. — Symptoms. — General Treatment. — 
Medicines. 



CHAPTER XVI. 

Tumors of the Generative Organs 180-187 

Classification: Benign Tumors, Malignant Tumors, Myomas, 
Fibroids, Polypus, Ovarian.— Enlargement of the Fallopian 
Tubes. — Salpingitis.— Tumors at the Change of Life. — Electricity 
for treating Tumors. — Symptoms and Diagnosis of Tumors. — 
Causes. — Medicines. 



CHAPTER XVII. 

Cancer or Malignant Disease of the Sexual Organs, 188-191 

Causes of Cancer.— Symptoms of Cancer.— Diagnosis, i. c, how to 
tell Cancer. — Duration of Life with Cancer. — The Treatment of 
Cancer. 



Vlll CONTEXTS. 



PART II 



A Domestic Handbook of Midwifery, witii SUPPLE- 
MENTARY CHAPTERS. 



CHAPTEB I. 

I'M.] 

Conception.— Signs <>r Pregnancy i ( ,).")--2ni> 

Conception. — How It occurs. — Where and when.— The ovum. — The 
Spermatozoa.— The Union of tin' Elements.— Ovulation. — Dura- 
tion of Pregnancy. — Calculation for Date of Delivery.— Size of 
the Abdomen at different Months.— 8igns <>t Pregnant 



CHAPTEB H. 

Hygiene of Pregn lnci 308 

Rules for Diet.— How to -elect Food. — Food which digests.— Diet 
:ui(l Easy Labors.— Changes in the Maternal Blood. — Decay of 
the Teeth.— Dress in Pregnancy. "-Management of Breasts.— 
Care of the Skin.— Prevention of Miscarriage. — Bathing.— The 
Production of Sex at Will. — Birthmarks.— Maternal Impres- 
sions.— Ancient Customs. — Irritability and Nervousni 

CHAPTKB III. 
Diseases <>i Pregnancy 213 

Morning Nausea and Vomiting. — Its Causes and Treatment. — Diet 
and Medicine. — Salivation. — Toothache. — Remedies.— Heart 
burn.— Constipation.— Itching of the Genitals. — Leucorrhcea. — 
Abortion. — Miscarriage. — Premature Labor. — Viability of the 
Child.— Law for Committing Abortion.— Unfortunate Girls.— 
Baby Farmers. — Miscarriage, Causes, Symptoms, Treatment, 
Medicines.— Heart Disease. —Consumption.- Convulsions. 

CHAPTEB LV. 
Preparations for Labor 227-248 

Labor, what it is.— Preparations for Baby.— Cradles.- How to make 
a Bassinei — Baby's Basket; how to make it and what to put in it. 
— Articles for Baby's First Toilet, and how to make them.— The 
First Clothes or the Layette. —The Standard Suit, also known a- the 
Reform Suit. — Patterns and Description of them. — Knit Suits. — 
Diapers. — Flannel and how to cleanse it without shrinking.— The 
Baby's Laundry.— Belly ban da, how to make, to wear, and to use 
them. — List of Articles for Baby's Use. —Night-wear lor Babies. — 
Shortcoating the Baby. — Standing Stools.— Preparation of the 
Room and Disinfection.— Preparations of the Mother. — List of 
Articles. — Antiseptic Pads.— Arrangement of Bed. — Signs of 
Labor. — True and False Pains. — When to send for the Doctor.— 
Engaging the Nurse.— Arrangement of the Hair. 



CONTEXTS. IX 

CHAPTER V. 

PAGE 

Labor . 249-209 

Process of Labor, and how the Child is born. —Position of the Child in 
the Uterus. — The Bag of Membrane. — The Liquor Amni. — The 
Placenta or Afterbirth. — Head Presentations, Breech Presenta- 
tions. — Transverse or Cross Births. — Twins. — Best Age for Labor. 
— Signs of beginning Labor. — Stages of Labor.— Management of 
the Stages of Labor. — How to deliver a Baity, and the Placenta or 
Afterbirth. — Cauls. — Nourishment. — Arrangement of Clothing. — 
How to prevent Tears and Lacerations in Childbirth. — The Man- 
agement of the Cord over the Child's Neck. — How to make the 
Baby cry when it is born. — The Prevention and Treatment of 
Hemorrhage. — The Use of the Binder. — Management of Breech 
Cases. — The Use of Ether and other Anaesthetic- in Labor. 



CHAPTER VI. 
The Puerperal or Lying-in Period 270-290 

Diet after Confinement for Successive Days after Delivery. — Gruels, 
Soups, Milk. Meat, Eggs. —Serving of Food. —Ventilation of the 
Room. — Visitors. — The Bladder and its Management. —Constipa- 
tion, Piles.— The Vaginal Douche. — The Napkins. — The Lochia. 

— A f terpains. — Nursing after Delivery. — Remedies for Afterpains. 

— The Care of the Breasts. — Sore, Cracked, or Abraded Nipples. 

— Caked Breast. —Nursing the Baby. — Drying up the Milk.— 
Remedies for Abscess of the Breast or " Broken Breast." — Milk 
Leg ami its Treatment. — Puerperal Fever. — Childbed Fever. — 
Blood Poisoning, its Management. Causes, and Treatment. 



CHAPTER VII. 
The Care of the New-born Child 291-311 

Signs of Maturity, or Babies born at Full Time. — Misshapen Heads. — 
Facial Paralysis. — Baby's First Toilet. — The Care of the Eyes. — 
Bathing in Winter and Summer. — How to bathe the Baby. — Man- 
agement of a Baby afraid of the "Water.— The Folding Bath-Tub. — 
Dressing the Cord. —Dressing a Sore Navel. — The Best Baby 
Powder, and how to make it. — Bellybands, how to apply and when 
to wear them. — Feeding the Baby. — Conditions preventing Nurs- 
ing. — Signs of Healthy Nursing. — Gaining in "Weight. — When to 
nurse the Baby.— Hours and Rules for Nui\sing. — Diet for Nursing 
Women. — Disagreement of Food. — Artificial Foods. —Wet Nurses. 
— Analysis of Milk. — Tests of Good Milk. —Sterilizing Milk.— 
Weighing the Baby. — Hours for Feeding and Quantity of Food for 
Different Ages and Weights. — Milk ami Cream Mixtures. — Steriliz- 
ing Apparatus.— Lime Water, Barley Water, Oatmeal Water.— 
Arrowroot. — Weaning the Baby. — Solid Food. — Sweating of the 
Head. — Chafing. —The Incubator. — Premature Babies. — Nursing 
Sore Mouth, its Causes and Treatment. 



CONTENTS. 



CHAPTER VIII. 

PAGE 

Face, Form, and Beauty ........ .... 312-346 

Relation of these to each other and to Natural Gifts. — The Importance 
of Good Gait and Figure.— How a Fine Carriage can be acquired. 
— " Setting-up '* Exercises. — Corsets. — Good Complexions and how 
to preserve and acquire them. — The Care of the Skin. — The Color 
of the Skin.— The Gymnasium for Ladies.— The Development of 
the Bust.— Scrawny Necks. — "Water, Pure and Impure, how to 
use it and what to mix with it. — Ammonia, Alcohol, Hay Rum, 
Whiskey, Vinegar Soap, Glycerine, Washing Powder, Bathing.— 
Egyptian Loofahs —The Use of Eats. — Pomades, how to BOfteu the 
Hands. — Cosmetics, how they are applied. — Face Powders, how t" 
make and how to use them. — Complexion Powders. — Wrinkles 
Freckles, Tan, Sunburn, Prickly Seat, Yellow Spots, or Liver 
Spots, Red, Scaly Spol •lrthmarks. — Excessive Perspira- 

tion, Oily Perspiration.— Oily or Greasy Hair. — Sweating ol the 
and under the Arms.— Pimples.— Hair on the Face. — Bleach- 
ing of the Hair.— Baldness and how to core it. — Dandruff.— I 
Lngthe Hair. — The Lips and how to care for them. — Bad Breath 
and how to cure It.— The Care of the Bands and how to make 
them Soft and White.— Chapped Hands.— The Polishing, Coloring, 
and Care of the Nails, Ingrowing Nails, Bangnaile. — Corns and 
how to cure them. 

Index . 



ILLUSTRATIONS. 



Plate I. 
Colored Plate I. 

Plate II. 

Figure 1. 

" 2. 

" 3. 

" 4. 

- 5. 

6. 

Plate III. 

" IV. 

u y. 

" VI. 

" VII. 

Figure 7. 
" 8. 

" 9. 

" 10. 

Plate VIII. 

Colored Plate II. 



Figure 11. 


" 12. 


Plate IX. 


• X. 



Colored Plate III. 

Plate XI. 
Fig. 13. 
Fie. 14. 



PAGE 

The Normal Pelvic Organs , 25 

The healthy Cervix Uteri before and after Child- 
bearing, showing Lacerations in the Womb 28 
Relation of the Pelvis and its Contents to the 

Surface of the Body 29 

Baker's Douche Pan 48 

Southwick's Modification to avoid tilting . . 48 

Reynold's Siphon Bedpan 48 

Reservoir or Pail for Vaginal Douche ... 48 

Southwick's Ointment Injector 84 

Southwick's Pastille for self-treatment ... 84 

Retroversion of the Uterus ....... 125 

Retroflexion of the Uterus 126 

Prolapus Uteri, or Falling of the Womb . . . 130 

Anteflexion of the Uterus 131 

Retroflexion of the Uterus and Prolapse of the 

Ovary with Adhesions ........ 136 

Knee Chest Position to replace the Uterus . . 136 
Exercise to strengthen the Abdominal and 

Pelvic Muscles 138 

Percussion of the Spine 139 

Dry Cell Battery for Domestic Use .... 140 
Uterus held in Position by a Retroversion 

Pessary 144 

Congestion of the Cervix Uteri. Laceration 
of the Cervix and Erosion falsely called 

Ulceration 149 

Southwick's Pastille for self-treatment . . . 102 
Forms of Uterine Myomas (Fibroids) and Poly- 
pus in the Cervical Canal ...... 181 

Ovarian Tumor in the Left Side of the Pelvis . 185 
Salpingitis involving the Right Fallopian Tube 

and Ovary 186 

Cancer of the Uterus, Epithelioma, and Scir- 
rhous Cancer 189 

Side View of Cancer of the Uterus . . . . . 190 

A Bassinet 228 

Baby Basket 230 

Pattern Sheet for Standard Reform Suit . , 233 



XH ILLUSTRATIONS. 

PAGE 

Fig. 15. New Style Knit Diapers 234 

Fig. 1G. Old Style of Diaper ... 234 

Fig. 17. Gored Diaper 235 

Fig. IS. Standing Stool 241 

Fig. 19. Eureka Bedpan .... ...... 244 

Plate XII. Head Presentation 240 

Plate XIII. Breech Presentation 250 

Plate XIV. Transverse Presentation 251 

Plate XV. Twin Presentation 2.~>J 

Fig. 20. Folding Bath-Tub 

Fig. 21. Hub Nursing Bottle 306 

Fig. 22. The differed Parts ol the Arnold sterilizer . 307 

Fig. 23. The Incubator 310 

Fig. 24. The Stamp of the Toilet Preparations . . . 317 



PART FIRST. 



A Do3iESTic Handbook 



OF THE 



DISEASES OF WOMEN. 



DOMESTIC HANDBOOK 



OF 



THE DISEASES OF WOMEN 



CHAPTER I. 
INTRODUCTION. 

The value of a book is often diminished by not 
knowing how to use it. The author, therefore, desires 
to make some remarks on the best way to under- 
stand this work. Great care has been taken to give 
the reader accurate information, and to describe the 
treatment as clearly as possible. Unsafe measures, 
theoretical or untried remedies, are not mentioned. 
The advice given in its pages has been used repeatedly 
with success by the author in some years of experi- 
ence in foreign hospitals, home institutions, or in 
private practice, also as a teacher for the past ten 
years in one of the most prominent medical schools 
of this country. 

It is not to be supposed that every disease or every 
remedy is mentioned. It would only confuse the reader 
uneducated in medicine, and serve no good purpose. All 
those diseases suited to domestic treatment are carefully 
considered, and as far as such treatment can be of ser- 
vice, it is fully described. The chapter on "Anatomy" 
needs to be read carefully, to obtain a correct knowledge 



10 INTRODUCTION. 

of the relation of the parts to one another and of their 
correct names. If terms are employed which are not 
understood clearly, reference to any good dictionary will 
make plain the meaning. 

When the reader desires information on any partic- 
ular subject, the index should be consulted. The greatest 
difficulty will be the selection of a remedy. It is scarcely 
probable that the most difficult thing for a physician to 
do correctly will be easy for a layman. The presence 
of only one or two symptoms makes a case generally 
difficult to prescribe for, as there are so few indications. 
Almost always in such cases careful observation will 
detect constitutional peculiarities or conditions of being 
better or worse, which will give the correct clew to the 
remedy. In other cases, the multitude of symptoms 
seems to indicate any remedy in the materia medica. 
The same principle here of observing constitutional 
symptoms and conditions of aggravations and ameliora- 
tions will certainly narrow down the list of remedies t<> 
a limited number, when a careful comparison of symp- 
toms will enable the reader to prescribe correctly in 
most cases. The large number of symptoms given i- 
often perplexing, especially when the sick person does 
not experience half of those mentioned. The rule is a 
good one, that for a remedy to be indicated there should 
be three clearly defined and separate symptoms ; addi- 
tional ones may be desirable, but it is not necessary for 
every symptom to be present which is mentioned under 
a remedy. For instance, delayed and scanty menstrua- 
tion (one symptom) in girls or women of a timid, sad. 
or melancholic disposition (constitutional symptom 
subject to palpitation of the heart or constant chillini 



INTRODUCTION. 11 

better oat of doors and worse in a warm room and in 
the evening, furnish excellent indications for Pulsatilla, 
and other symptoms indicating it would add to its im- 
portance. 

The term "constitutional symptoms" has been em- 
ployed, which implies a classification of symptoms into 
constitutional and non-constitutional groups ; the former 
refers to the peculiarities of an individual, the tempera- 
ment ; conditions of skin, of circulation, of perspiration, 
of menstruation ; of getting worse and getting better ; 
all of which have reference to the individual and her 
constitution, and are often of more importance in select- 
ing a remedy than more prominent and local symptoms. 
It is strange, but true, that the symptoms which are often 
complained of the most, as local sensations or pains, for 
example, are often of little importance, and are less re- 
liable than the constitutional symptoms in selecting the 
best remedies. The non- constitutional symptoms are 
almost always the more prominent and usually are 
directly connected with localized disease. Take, for 
instance, Silicea and its indications for painful men- 
struation. We will note first the constitutional symp- 
toms, oversensitive, weakly women, fine skin, pale face, 
light hair, light complexion, and lax muscle ; or ner- 
vous, irritable women with dry skin, subject to diarrhoea 
or constipation, and perspiration at night. They usually 
feel better in a warm room and from wrapping up 
warmly, and are worse in the open air. They are sub- 
ject to offensive sweating under the arms, and more 
often of the feet, with soreness between the toes, brittle 
finger-nails and hang-nails. These symptoms are con- 
stitutional, and have no special connection with any one 



12 INTRODUCTION. 

disorder ; but they show the susceptibility of the con- 
stitution to Silicea, so that if other symptoms were 
vague, these alone would point to the correct remedy 
with considerable certainty. The non-constitutional 
symptoms for Silicea will now be mentioned, and you 
will observe they are much more prominent, though 
not more important than general constitutional symp- 
toms remote from the scat of disease. Some of them 
partake of a constitutional character, such as icy cold- 
ness of the whole body at the commencement of the 
menstruation, and always being cold during the men 
while the following are of a non-constitutional char- 
acter : Agonizing pains during the first day and a half 
of the menses. How very profuse, dark colored, clotted, 
a little offensive and protracted, sometimes excoriating 

the thighs; watery or milky discharge, instead of the 

regular menstrual discharge : itching, burning, smart- 
ing, or soreness about the external parts ; diarrhoea .just 

before menstruation and with the first part of it. Th 
symptoms are all important, and would indicate the 
remedy, if no constitutional symptoms were observed. 
The fact is, that, with very rare exceptions, both clae 
are present, and I desire to emphasize the tact that we 
cannot remove one group of symptoms from the organ- 
ism and treat those alone, any more than we can blot 
out the central figure of a beautiful painting without 
defacing it. The human organism is most marvellous in 
composition, and the intricate and delicate adjustment 
of its component parts requires harmony of action be- 
tween them ; a defect of any one portion always dis- 
turbs that finely adjusted balance of action which we 
call health. 



INTRODUCTION. 13 

Accurate prescribing of medicine can be likened to 
the tine arts. Any one can daub, and but few can paint 
with the genius of a great master. Any one can pre- 
scribe medicine, but there are very few physicians who 
can prescribe exactly the right medicine every time. 
Prescribing is not merely mechanically dealing out 
drugs. It requires a keen discernment of the value of 
symptoms, of a patient's constitution, and extensive 
knowledge of drug action, which may well be called 
a genius for prescribing, and is not common among 
physicians. This being the case among medical men, 
non-medical persons should not be surprised when they 
fail to obtain the desired results. The physician fails 
often to cure a case because the patient has not men- 
tioned fully everything in connection with it. An ex- 
cellent plan is to take the list of questions given below 
for a guide in stating your case to your physician, as 
well as in writing down the symptoms for self -treat- 
ment and comparison with the symptoms mentioned in 
this book. 

It may be well to state here that these symptoms 
are too minute to be understood by allopathic physicians, 
but always will be appreciated by a careful prescriber 
of homoeopathic remedies. It is no spirit of sectarian- 
ism which compels me to state what I knoiv to be a fact 
and have repeatedly witnessed, i. e., the superiority of 
homoeopathic remedies in treating diseases of women. 
It entirely does away with a large amount of local 
treatment, excepting cleanliness, and will save patients 
from an operation in more than seventy-five per cent 
of cases applying for treatment. There are some things, 
such as tumors and laceration of various tissues, which 



14 INTRODUCTION. 

require surgical aid ; but excepting this limited class 
of patients, nearly all can be cured by homoeopathic 
remedies, and with but little local treatment. Did 
women only half appreciate these facts, the saving of 
those ordeals for unmarried women and mothers, the 
pain often caused by local treatment, the use of strong 
caustics, and the common resort to removing ovaries, 
which might be avoided by homoeopathic remedies. 
there would be fewer specialists among the allopathic 
fraternity. It is true that such treatment finally results 
in curing many patients, but at a fearful comparison 
with the method advocated. Mild local treatment is 
used with much advantage in some cases: hut the local 
treatment in the two school- of medicine differs con- 
siderably and should, with rare exceptions, be entirely 
secondary to the action of medicines. 

The arrangement of the remedies is simple. The 
most important are distinguished by a double bar < II >, 
the next important by one bar | | >, and the more com- 
mon remedies are not marked. The most characteristic 
symptoms are usually given in Italics. These marks 
merely indicate the relative importance of remedies and 
symptoms, and are not to be used in merely guessing 
that because a remedy has a double bar and the most 
symptoms, it is the remedy to use. The rule is to use 
always that remedy which gives the best description of 
the patient and her feelings. 

Immediate relief is sometimes given, but it is the 
exception to the rule. It is characteristic of most of* 
the diseases peculiar to women, that they develop slowly 
and insidiously, and before the patient realizes it her 
complaint is chronic and has obtained a firm hold on 






INTRODUCTION. 15 

the organism. Such conditions of disease always re- 
quire time and patience to overcome them. A remedy 
ought not to be taken by hazard or guesswork, but by 
a careful. study of the case, and one well-selected remedy 
is better than two medicines taken in alternation. The 
directions for taking medicine are given in each chapter. 
The frequency for acute cases varies from two to four 
hours apart, according to the severity of the symptoms. 
In chronic cases, the frequency of the dose varies from 
three times a day, half an hour before meals, to once in 
one or two weeks. A common mistake is to change 
the remedy too soon, which is sometimes done by 
physicians. In acute cases, as they occur in diseases 
of women, the remedy should be continued one day at 
least, and better two, before changing, and in chronic 
cases no change should be made for one or two months. 
It sometimes happens that, soon after a dose of medicine 
has been taken, the patient feels worse. This means, as 
a rule, that the selection of the remedy has been correct, 
but that it is too strong. Under these circumstances, if 
the remedy has been prepared in water, mix one part 
of this and add ten times as much water, and continue 
the last mixture with the same frequency and dose as 
with the former mixture. If the remedy is in pills, 
powder, or tablets, procure a fresh bottle of double the 
decimal of the first, and take it in the same way ; i. e. , 
if aggravation followed the use of the third decimal 
preparation, then use the sixth. 

The use of the third decimal preparation of drugs 
leads me to make some explanation of its meaning. In 
homoeopathic pharmacy the purest and best drugs it is 
possible to obtain are prepared with alcohol if they are 



16 INTRODUCTION. 

soluble, or ground with sugar of milk if insoluble ; the 
former results in a liquid preparation, and the latter in 
a powder. These preparations are graded on a decimal 
scale ; the larger the number the finer the subdivision 
of the original substance, and the less there is of it. 
The scale is written by the number of the scale and x 
for ten after it; i. e., 3x means the third decimal prep- 
aration. 

Pills of different sizes are made of sugar. Four of 
number three medicated pills are an ordinary dose. 
Disks are made of the same material, are more absorb- 
ent than pills, and are about the size and shape of split 
peas. One medicated disk is a dose. Tills and disks 
are used to absorb the Liquid medicine, which is 
easily spilled in the pocket. The rule in medicating 
them is to pour on enough of the Liquid medicine to 
thoroughly saturate the pills or disks. After a few 
months they will dry up and need to be saturated again. 
A bottle or cork should never be used for any other 
than tbe original remedy. Washing the bottle will not 
cleanse it sufficiently to safely put another kind of 
medicine in it. The powder may be taken as it i>. dry 
on the tongue, either what will stay on the point of 
the penknife, or a powder the size of a pea, for a d< 
The powder is also prepared by the pharmacist by mix- 
ing it with alcohol and pressing it in glass moulds into 
small tablets, one tablet constituting a dose. 

Liquids and powders can be mixed in water, which 
sometimes promotes the action of the remedy. The 
amount to mix varies with the strength of the remedy : 
but if the third decimal preparation or a higher number 
is used (the third is generally recommended), mix eight 



INTRODUCTION. IT 

drops of tlie liquid medicine in eight tablespoonfuls of 
cold water ; or if the medicine is in powder form, as 
much powder as will lie on a ten-cent piece is the proper 
proportion to the above amount of water. Two tea- 
spoonfuls is the dose of either mixture, which should be 
kept covered in a cool, dark place. 

Such dilutions of drugs, even when they are of the 
utmost purity, seem hardly efficacious ; but the great 
fact which every sick person has in mind is to get well. 
All things equal, the less medicine taken the better, for 
the system has to dispose of it in some way, and the less 
it is taxed, the better for the patient. Homoeopathy 
aims at giving as much medicine as is necessary to cure 
a patient, but no more. Experience is demonstrating 
every day the efficacy of small doses and the danger of 
large ones. 

It is possible that you are situated away from such 
a physician as you would like to consult, and you desire 
an opinion or medicine by mail. It is not an easy thing 
to give an accurate statement of your case, and for this 
reason I would advise you to follow carefully the sched- 
ule given below. If you are a stranger in a place, and 
desire to employ a homoeopathic physician, ask if the 
physician is a member of the American Institute of 
Homoeopathy and a graduate of a homoeopathic med- 
ical school in Boston, Xew York, Philadelphia, or Chi- 
cago. There are other good colleges, but these are the 
more important and the largest. If a physician can 
answer yes to the first question anyway, and also to the 
second, he or she is to be considered in good standing. 
If the answer is negative to both questions, another 
physician with better requirements should be sought. 



18 INTRODUCTION. 

Unfortunately there are both educated and uneducated 
persons who trade upon the name of homoeopathy, who 
do not practise it or know much about it. There is no 
advantage in employing such a physician. You are 
perfectly justified in asking for the credentials of a 
stranger. 

The following guide, with a closing paragraph on 
dietetics, is for those who wish to consult a physician 
by mail : — 

Guide to Fatients. 1 

Patients wishing to consult a doctor should carefully 
consider the following questions, and set down the 
answers, numbering cadi, in clear and precise terms. 
They should slate the hour of day or night when they 
feel better or worse, the conditions relieving or increasing 
their pains, and any accompanying symptoms. If 
impatient or depressed, apprehi nsivi or inclined to 
tears, they should be particular to mention the causes. 
Xo symptom, however trivial, should be omitted. With- 
out the above details, effectual, accurate prescribing is 
impossible. 

Patients should keep a copy of each letter they Bend 
the doctor, and read it over, together with the list of 
questions, before writing again. They will be careful 
to report any changes that may take place in their con- 
dition, such as the disappearance of any old, or the 
appearance of any new symptoms. 

1. Please state your age ; married or single ; tem- 
perament ; complexion ; color of hair and eyes ; inher- 
ited diseases. 

1 Arranged from a guide for patients by Drs, II. L. Thurston and 
Prosper Bender. 



INTRODUCTION. 19 

2. Height ; weight, increase or decrease lately. 

3. Causes of death of parents ; if living, state of 
health. 

4. Previous illnesses ; skin diseases ; discharges 
suppressed ; enlarged glands. 

5. . Cause or causes of present illness, if traceable ; 
recent, or long standing. 

6. Treatment followed ; names of medicines, if 
known. 

7. Disposition ; mental state ; irritability ; impa- 
tience ; depression ; weeping ; confusion ; fears ; hallu- 
cinations ; anxiety ; groaning ; memory. If any grief 
or affliction, state its nature. 

8. Head. Dizziness. Scalp. Hair. Eyes ; sight. 
Ears ; discharges ; noises ; hearing. Nose ; discharges ; 
smell. Perspiration. 

9. Face ; expression ; color ; freckles. 

10. Tongue ; color. Gums. Mouth ; dryness ; sa- 
liva increased ; thirst ; canker ; taste ; breath. Teeth ; 
upper or lower. 

11. Throat; lump. Tonsils. Palate; sensations; 
hawking mucus, . color ; effects of swallowing saliva, 
liquids or solids. 

12. Appetite ; desires and aversions (food) ; hot or 
cold drinks. 

13. Belching, with taste ; relief or not from bring- 
ing up wind. Nausea. Vomiting, bile, mucus, food, 
blood. Hiccough. Heartburn ; acid, bitter risings. 

14. Stomach ; distention ; fulness ; lump ; gone- 
ness ; burning ; better or worse from food ; effects of 
pressure of clothing. 

15. Abdomen (belly) ; distention ; tenderness ; ful- 
ness ; goneness ; rumbling ; relief or not from flatus. 



20 INTRODUCTION. 

16. Constipation; stool, form, size, color; desire to 
stool without result ; lack of desire if affected by menses. 

17. Diarrhoea ; painful ; painless ; character, bloody, 
watery, fecal, mucus, color, odor ; pain before, during, 
or after stool ; relief or not from stool ; straining ; 
frequency, if affected by menses. 

18. Piles; internal; external; bleeding; painful; 
itching ; effects from stool ; fistula. 

L9. Urine; color: smell; quantity; sediment; 
cloudiness, at once or after standing; urination, invol- 
untary, painful, urgent ; burning, before, during, after ; 
frequency. 

20. Mouses; late; early; scanty; profuse; color : 
odor : location of pain : symptoms worse, before, during, 
after ; relief or aggravation of symptoms during flow. 

21. Leucorrhoea I whites ; color ; odor ; consistency ; 
excoriating ; before, or after mens 

22. Womb ; cramp ; bearing down ; ovarii 

23. Cough; hoarse; croupy ; dry; loose; painful. 
Sputa (expectoration i. scanty, profuse, stringy, color. 
taste ; sputa, easy, difficult ; not raised, but swallowed. 

W J4. Voice ; hoarse ; weak ; lost. 

25. Heart; palpitation ; pain; faintne 

26. Chest; pain; breathing; sighing; oppression; 
emptiness. 

27. Linibs; coldness; numbness; cramps; perspi- 
ration, cold or warm; restlessness. 

28. Back. Neck. Shoulders. Spine, above or below 
waist. 

29. Sleep, light or heavy : posture, on back, right 
or left side. Dreams. Sleeplessness, before or after 
midnight. Sensations on awaking. 



INTRODUCTION. 2 1 

30. Skin ; dryness : moisture ; eruption ; open sores ; 
itching : warts. 

31. Fever : chills : sweat, hot or cold, odor, partial 
or general ; thirst, at what stage. Kelief, or not. from 
sweat. 

32. Languor ; weakness : faintness. Eestlessness 
with pains. 

33. Hours of aggravation or improvement; seat of 
pain, right or left side; character of pain, burning, 
stinging, shooting, throbbing, continuous, or intermit- 
tent: direction of pain ; causes of increase or decline, 
such as motion in general : moving the affected part : 
lying down, on the back, on painful or painless side; 
sitting: walking: modal exertion, or excitement : hot 
or cold applications; warm or cold room: open air; 
noises: jarring : friction or pressure : weight of clothes ; 
eating : fasting ; drinking ; swallowing ; sleeping : 
changes of weather and temperature ; wrapping up 
warmly; heed of stove; washing the part; light: 
sun ; etc. 

Avoid fried or greasy food, salads, pickles, coffee, tea. 
pastry, hot biscuits, ices, ice-water, and stimulants. 

Mineral waters. " tonics," cathartics, "patent med- 
icines." local applications, strong perfumery, confec- 
tionery, and strong dentifrice preparations are forbidden. 
When under a physicians care no medicines should be 
used except those prescribed by the doctor himself. 

Eat ripe fruits, vegetables, Graham bread, and easily 
digested food generally. 

I have found Codman & Shurtleff, Boston. Mass 
very reliable firm for the purchase of surgical instru- 
ments and similar appliances. In purchasing medicines 



'22 INTRODUCTION. 

I would earnestly caution my reader to procure them 
direct from one of the following firms, rather than from 
the ordinary druggist who assures her that his prepara- 
tion is just the same or just as good. They may be in 
some cases, but there is no certainty about it. 

Boston, Mass. : Otis Clapp & Son, 10 Park Sq., or 2 
Beacon St. 

Providence, R. I. : Otis Clapp & Son, 317 Westmin- 
ster St. 

New York, N. Y. : Boericke & Tafel, L45 Qrand St. 
and 7 W. 42d St. ; Henry M. Smith, L30 AY. 23d St. : C. 
T. Hurlburt, - E. 19 St. 

Philadelphia, Pa. : Boericke & Tafel, 921 Arch St. 

Baltimore, Md. : Boericke & Tafel, 228 No. Howard 
St. 

Pittsburg, Pa. : Boericke & Tafel, 627 Smithfield St. 

Washington, D. C. : Boericke & Tafel, 938 F St., 
N. AY. 

Chicago, 111. : Gross A Delbridge, 4^ Madison Ave. ; 
HalseyBros.. 27 Washington st. ; Boericke & Tafel, 
E. Madison St. 

Cincinnati, Ohio: A. F. Worthington & Co., L70 
W. 4th St.; George \Y. Smith. 14:; \Y. 4th St. 

St. Louis, Mo. : Luyties Homoeopathic Pharmacy 
Co., 306 AY. Broadway ; Mimson <Sc Co., 411 Locust St. 

San Francisco, Cal. : Boericke & Runyon. 234 Sutter 
St. 

New Orleans. La, : F. Englebach, L54 Canal St. 

Milwaukee, Wis. : Louis Sherman, 448 Jackson St. 

St. Paul, Minn. : Taylor oc Myers Pharmacy Co. 
109 E. 7th St. 

Minneapolis, Minn. : Thomas Gardiner. Nicollet Ave. 






INTRODUCTION. 23 

Kansas City, Mo. : Luyties Homoeopathic Phar- 
macy Co. 

Cleveland, Ohio : J. Petlett, 295 Erie St. ; L. H. 
Witte, 350 Superior St. 

Nearly all of these pharmacies will be able to fill 
orders for syringes, instruments, and most of the pre- 
scriptions mentioned in this book. Messrs. Otis Clapp 
& Son, in Boston, manufacture the cerates and oint- 
ments I use, and I can recommend them warmly to my 
readers. 



CHAPTER II. 
THE ANATOMY OF THE FEMALE PELYIC ORGANS. 

The subject of this chapter has been the theme for 
many volumes, but it is quite unnecessary for the pur- 
pose of the present work to describe more than is suf- 
ficient for the requirements of domestic practice. A 
woman should have an intelligent idea of those orpins 
peculiar to her sex, which have so much to do with her 
health and usefulness in life. It is true that a little 
knowledge sometimes becomes a dangerous thin-', and 
it is equally true that the same knowledge properly 
used may save health and strength, and enable a patient 
to state her case with much more accuracy to the family 
physician. 

The external genitals, sometimes called the vulva, 
refer to those parts outside the body. The two folds on 
either sid9 are called the labia, or lips in the English 
equivalent, which is seldom used. The larger <>iifice 
between them is the vagina, and in front of this, close 
to the bony arch, is a small opening not so largo as a 
pipestem which is the mouth to the urethra, a small 
canal less than two inches long communicating with 
the bladder. The urine is always passed through this 
canal, if the bladder and its connections with the kidneys 
are in perfect condition. Posterior to the vagina and 
labia is the rectal orifice called the anus, through which 
the discharges from the bowels pass. The portion of 
the bowels just above the anus is the rectum. External 




PLATE I. 



Section through the body showing the natural relations of the pelvic organs. 
The dotted lines above and below the uterus show the normal movements of the 
uterus (U) depending on the amount of urine in the bladder (B). S, symphysis 
pubis. P, perineum. R, rectum. O, ovary. T, tube. The white band from U to- 
ward S is the round ligament holding the uterus in place anteriorly. The vertical 
lines beneath it indicate the broad ligament. 



THE ANATOMY OF THE FEMALE PELVIC ORGANS. 25 

piles, which are often painful and itch severely, are 
dilatations of the veins, which protrude like pieces of 
skin about the anus. Internal piles are similar dilata- 
tions within the rectum, and, as they often bleed, are 
commonly called bleeding piles. 

The accompanying illustration was prepared spe- 
cially for this work with great pains to insure accuracy. 
It represents the female pelvis and the organs it con- 
tains cut straight through in the middle, so as to form 
two equal halves. 

A straight line extends up over the uterus (U, Plate 
I.) from the top of the symphysis pubis to a projecting 
portion of the spinal column. This line indicates the 
boundary between the false pelvis above and the true 
pelvis below. As the child grows, it develops together 
with the uterus up into the false pelvis, and then extends 
up into the abdominal cavity. In consequence of some 
diseases, more especially rickets in childhood, the pro- 
jection of the spinal column (the promontory of the 
sacrum >, at the upper of the straight line, projects down 
too far into the pelvis, and diminishes the space so as 
seriously to interfere with the birth of the child. This 
is then a deformed or contracted pelvis. Other forms 
of contracted pelvis exist, but this is the most common 
one. Genuine deformity of the pelvis is rare among 
American women ; but it is comparatively common in 
some European districts, especially in the upper portion 
of the valley of the Ehine. 

The external organs, as mentioned above, will be 
easily found. The labium is covered with hair. At 
the back part of it is a depression in which two canals 
enter. The anterior one is just beneath the symphysis 



26 THE ANATOMY OF THE FEMALE PELVIC ORGANS. 

pubis or "front bone," marked S. This canal is the 
urethra or water passage, already mentioned, leading 
to the bladder, marked B. The other canal below the 
urethra and to the right of it in the illustration is the 
vagina. This communicates with the uterus above (U >. 
and is the organ of congress. The monthly discharge 
passes through it, and also the infant in childbirth. It 
is often mentioned as the front passage, in contradis- 
tinction to the rectum (R), which is then termed the 
back passage. The walls of both the vagina and rec- 
tum lie together in contact, and exclude the air under 
normal circumstances, if the rectum is empty. The 
vagina is one of the many wonderful provisions of Na- 
ture by which it is adapted to her purposes. Though 
ordinarily it is not much larger than the finger, this 
small delicate tube is so constructed that it can safel; 
expand in childbirth ; then its diameter will excee( 
three and a half inches, but within a fortnight ii 
regains nearly its former dimensions. It is a canal 
with the upper portion expanded to secure better reten- 
tion of certain natural fluids, and closes below at the 
entrance like a valve to protect important structures 
within the pelvis, and affords no small support to the 
uterus. 

On further reference to Plate I. , it will be noticed that 
the thin band or strip of tissue between the rectum and 
vagina, called the recto-vaginal septum, becomes broader 
at its outer margin on the surface of the body, and forms 
a portion of tissue wedge-shaped in appearance, with 
the base downward between the vaginal and rectal 
orifices, and the apex of the wedge directed upward. 
This small and apparently insignificant wedge-like strip 



THE ANATOMY OF THE FEMALE PELVIC ORGANS. 27 

of tissue is known as the perineum (P), and plays an 
important part in the female economy. Intimately 
connected with the muscles surrounding the rectal and 
vaginal orifices and the strong muscles on both sides 
forming the floor -of the pelvis, it holds them together 
like the tie of an arch, and is an efficient bulwark and 
support to the uterus. Let the reader imagine this 
perineum torn back from the vagina to the wall of the 
rectum, and it will be easy to see that the supporting 
column of the uterus is destroyed. 

The consequences are obvious. In the very great 
majority of cases, especially if the lady be a hard-work- 
ing woman, the uterus will descend and become mis- 
placed, with all its attendant evils. There are few 
operations more frequently performed for ladies than 
those for the repair of this injury, and the author feels 
compelled to remark that some of the methods em- 
ployed for this purpose are useless ; in fact, but very 
few operations are really efficient, and that these are 
never to be attempted by a novice or by any one not 
specially practised and experienced in the modern sur- 
gical treatment of female diseases. Only then will a 
suffering woman receive that great relief and benefit 
which follow a successful operation. 

The perineum is, unfortunately, very liable to rup- 
ture in childbirth, more especially with the first child, 
and always should be immediately stitched together. 
The physician who fails to examine carefully after 
labor for such injuries, and to repair them, shamefully 
neglects his patient. 

The uterus (IT) is an oblong organ about the size and 
shape of a small pear, with the large end upward. In 



28 THE ANATOMY OF THE FEMALE PELVIC ORGANS. 

it the most wonderful changes in the animal economy 
occur with the processes of childbearing. The lower 
portion of this hollow muscle, for such is really the 
uterus, projecting into the vagina like a nipple, is called 
the neck, or, Latinized, the cervix uteri. The upper 
portion, extending up among the intestines, is named the 
body of the uterus. A small black line extends through 
its centre to the vagina and communicates with it. The 
space above the neck, or cervix uteri, is the cavity of 
the uterus where the infant develops. Leucorrhoea 
most frequently depends on an inflammation of the 
lower portion of the canal in the cervix. This portion 
of the canal in the cervix is called the cervical canal. 
The menstrual flow comes from the capillary blood- 
vessels opening into the uterine cavity. If for any 
reason the cervical canal is very small or becomes 
spasmodically contracted, the menstrual blood cannot 
readily escape, and at the menstrual period causes much 
pain till it is discharged. 

Colored Plate I. shows exactly the size and appear- 
ance of the healthy cervix, and the change after child- 
bearing, which usually tears the womb. If the tear 
becomes inflamed, it causes much distress. (See colored 
Plate II., opposite page 14!». » 

The position of the uterus shown in the preceding 
illustration (opposite page 25) is the most natural one, 
but as the uterus, also known as the womb, is loosely 
held by ligaments which are not shown, it can be raised 
or lowered within the natural limits according to the 
amount of urine distending the bladder. This is shown 
by the dotted lines similar in shape to the uterus. 

The shading and lines above the bladder and uterus 
represent the peritoneum, a whitish, thin membrane 



COLORED PLATE I. 




The cervix and entrance of a healthy uterus which has not been impregnated. 
The black ring represents the vagina. (Heitzman.) 




The cervix and entrance of a healthy uterus after chiklbearing, showing its 
enlargement and a stellate laceration. The black ring represents the vagina. 
(Heitzman.) 



PLATE II. 



The relation of the hony pelvis and its contents to the surface of the body. 
S, symphysis pubis. B, bladder. U, top of uterus. T, Fallopian tubes. O, ovaries. 



THE ANATOMY OF THE FEMALE PELVIC ORGANS. 29 

forming a delicate sack over the bowels and a portion 
of the pelvic organs. An inflammation of this mem- 
brane is called peritonitis, a very serious and often 
a fatal disease. Observe that this peritoneum covers 
the uterus. It will be readily seen that any acute in- 
flammation of the uterus is easily communicated to the 
peritoneum, causing peritonitis. This is why the horri- 
ble crime of abortion so often ends in peritonitis, and 
the woman who thus escapes maternity goes to her 
grave with her soul stained with the murder of her 
unborn babe. 

On the upper portion of the uterus in the peritoneal 
cavity is shown the trumpet-like expansion of the Fal- 
lopian tube, which really is an inch and a half away 
from the uterus, and connected with the ovary, one on 
each side as shown in Plate II. One Fallopian tube (T) 
on each side extends from the upper portion of the 
uterine cavity to the ovary (0), and transmits the ovum 
from the ovary to the uterus. There is one ovary, 
about the size of the joint and end of the thumb, in each 
side of the pelvis. The ova develop in them, and it is 
estimated that there are thirty thousand in each ovary. 
No new ova are produced after birth, so that if the 
ovaries are destroyed by inflammation, or if the ovaries 
are absent or removed, a woman can never bear chil- 
dren. The ovum is the female element concerned in 
reproduction, and its parts are arranged just like those 
of a hen's egg. The ovum when it leaves the ovary is 
only a one hundred and twentieth part of an inch in 
diameter : yet when impregnated, this microscopic point 
of matter undergoes that mysterious evolution into a 
human being, with its almost infinite possibilities. 



CHAPTER III. 1 
THE CAUSES OF GYNECOLOGICAL DISEASES. 

Why are American women so prone to diseases 
peculiar to their sex? It may be considered an open 
question, if they are more affected than women of other 
nations. They have that reputation, however ; and it 
seems to be true, that those diseases characterized by 
various disturbances of the nervous system are not only 
more frequently met with in the United States than in 
other countries, but are also increasing. 

A young woman lias completed her education, per- 
haps with honor ; as a girl she was healthy and robust, 
but for some occult reason a peculiar train of nervous 
phenomena, called hysteria, is developed. 

Like the fly-wheel of an engine without the steadying 
influence of the governor, there seems to be a lack of 
correlation of the nervous fortes. The nicely adjusted 
balance between volition and impulse is. lost, and the 
harmonious action of the vital forces destroyed. The 
fault may be detected in a piece of machinery, but the 
human organism is so complex in its structure, that 
neither physiology nor pathology will always enable us 
to determine where the trouble lies. On further inquiry 
in the class of cases referred to, we are liable to find an 
unnatural condition of the monthly periods. They may 

1 This chapter is taken from the second edition of the author's 
Practical Manual of Gynecology, 1801. 






THE CAUSES OF GYNECOLOGICAL DISEASES. 31 

be irregular or profuse, and accompanied with a varying 
amount of ovarian pain. The patient may be subject to 
severe headaches, and in her later womanhood wonder 
why she is not as well as some of her friends. Like the 
hothouse plant, she can endure but little, and is easily 
affected by her surroundings. Both have been forced to 
bloom prematurely. At the time of puberty, the ner- 
vous forces are directed from their proper channels, and 
physical vigor is sacrificed to intellectual development. 1 
Instead of the outdoor sports and games of boys, rowing, 
skating, etc.. she is taught that such things are hoi- 
denish. While the boys are strengthening their muscles 
with plenty of outdoor air and exercise, she is practis- 
ing her music or reading the latest novel. When the 
menses appear, she is seldom warned and advised con- 
cerning them. Instead of taking perfect physical and 
mental rest at these times, she goes about as usual. 
Imprudence during the menstrual periods, from igno- 
rance of the consequences, is a fruitful cause of disease. 
Xo mother does her whole duty to her daughter who 
fails to point out and impress upon her the importance 
of this one thing. At this time, too, the girl just enter- 
ing into womanhood is undergoing the cramming pro- 
cesses of school life and various accomplishments. The 
generative organs, which are rapidly developed at this 
period, may suffer from malnutrition in consequence of 
the perversion of nerve force. One of our most promi- 
nent gynecologists believes this is a fruitful source of 



1 Dr. William A. Hammond has an interesting article on •• Drain- 
forcing in Childhood," in the Popular Science Monthly for April. 1887. 
He helieves that much injury is done by -ending children to school too 
young, and with too great a variety of studies. 



32 THE CAUSES OF GYNECOLOGICAL DISEASES. 

imperfect development of the sexual organs, with the 
consequences of various "weaknesses" and sterility, 
either absolute or relative. 1 

The demands of education are not the only ones 
made upon her. Fashion decrees that she must wear 
longer and heavier skirts and dresses, too often sus- 
pended from the waist instead of the shoulders. Tight- 
fitting corsets must be added to make the latter fit well, 
and still further impede the free circulation of the 
blood. Habits of luxury and ease also play a part. 
Sitting on stuffed easy-chairs compresses the sides of 
the pelvis and the blood-vessels, instead of allowing the 
pressure to come upon the ischial tuberosities, where 
nature intended. Bodily posture is not without its 
influence : too often, in sitting down, the pelvis is tilted 
upward and the body forward, the erect position is lot, 
and the weight of the intestines allowed to come di- 
rectly upon the contents of the true pelvis. 2 A similar 

1 Dr. Matthews Duncan attributes to it. not only sterility, but also 
"destruction of sensuality of a proper, commendable kind, and its con- 
sequent personal and social evils." The writer is quite sceptical con- 
cerning this statement, as patients of practically no education whatever 
in the lower classes complain of this fully as much as the better clas 
He would also ask, Why should higher education under the sami condi- 
tions affect the ovaries of a woman any more than the testicles of a man? 

Emmet, Principles and Practice of Gynecology, pp. 17-25. 

Sec Address of Dr. Moore on the Higher Education of Women. 
before the British Medical Association, British Medical Journal. Aug. 
14, 18SG, p. 295. Though agood summary of the opinions of various per- 
sons, he does not found his opinion on a personal investigation of sta- 
tistics bearing on this question. It is commended, however, by an 
editorial in the Journal of the American Medical Association, Sept. 4, 
18SG, p. 267. A very interesting reply, by Dr. Lucy M. Hall, of Vassar 
College, to Dr. Moore's Address, will be found in the Popular Science 
Monthly for March, 1887. 

See also Health and Sex in Higher Education, by John Dewey, 
Ph. D., Popular Science Monthly, p. 606, March, 1886. 

Compare Herbert Spencer's Principles of Biology. 

2 Bodily Posture in Gynecology, by Dr. S. J. Donaldson. 






THE CAUSES OF GYNECOLOGICAL DISEASES. 33 

condition is produced by wearing high -heeled shoes. 
All these tend not only to cause, but also to maintain, 
a chronic congestion of the pelvic organs from the very 
beginning of her sexual life. 

One of the best ways to study the social life of a 
nation is to observe the caricatures in its literature. 
Among the most common- we see are those of young 
misses discussing their parties, calls, beaux, fashions, 
theatres, etc. As if the evils of education and fashion 
were not enough, society itself must conspire against 
them, and demand their entrance into it two or three 
years before that of the opposite sex, the boys, who 
meantime have enjoyed far better opportunities for 
physical culture. 1 Girls should certainly be allowed as 
much time as the boys for higher education. The de- 
mands of society at an early age are a great and serious 
mistake, only adding to the high pressure and the ner- 
vous strain to which they are already subjected. Let not 
these remarks be misconstrued. I thoroughly believe in 
the higher education of women in whatever direction 
they may manifest peculiar talent and ability, and I also 
believe in giving the girls a fair chance. 2 Dr. Wier 
Mitchell believes a girl should not undertake hard study 
till after eighteen years of age. This is practically the 
opinion of Dr. Conrad Wesselhoeft, who expresses his 
opinion that a girl should not begin severe study till 
after sexual maturity ; after that, she may work her 
mind hard. It is not so much study as a lack of phys- 

1 Education of Girls connected with Growth and Physical Develop- 
ment. By Dr. Nathan Allen. In Journal of Psychological Medicine, 
Vol. V., Part 2, London, 1879. 

2 Dr. Edward II. Clarke, Sex in Education : or. A Fair Chance for 
the Girls. Also, The Building of a Brain. 



34 THE CAUSES OF GYNECOLOGICAL DISEASES. 

ical exercise, late hours, improper food and dress, which 
generally injure a girl's health. 

The remedy for these things is simple : plenty of out- 
door air and physical exercise, rest in a recumbent posi- 
tion during each menstrual period until regularity in 
time and quantity are established. 1 After this she need 
not lie down, but ought to have both physical and men- 
tal rest. Teach her proper care of herself, and the 
danger of suppressing the flow by wetting the feet, or 
sitting on the ground or on cold stones. Keep her a girl 
and out of society till at least the age of eighteen. From 
fourteen to seventeen avoid hard study and the reading 
of light literature. Moderate study with outdoor air 
and exercise, going to bed early and sleeping long, is 
not likely to injure any one. There will still be time 
enough for her to acquire a collegiate education if she 
wishes, and, if possible, develop into a strong, healthy 
woman. - 

After marriage there are three great causes of uterine 
disease : prevention of conception, the induction of abor- 
tion, and lack of proper care during and after parturi- 
tion. It is impossible to condemn too strongly tin 1 cold 

1 Dr. Mary P. Jaeobi, in her essay on The Question of Rest for 
Women during Menstruation (p. 231), expresses her opinion that 
"mental work exaeted in excess of the capacity of the individual may 
seriously derauge the nutrition" in young persons; hut she thinks 
there is no need of rest for healthy icemen during menstruation. 

2 The health statistics of female college graduate.-, in the Sixteenth 
Annual Report of the Massachusetts Bureau of Statistics of Labor, 
show that the health of such graduates bears a favorable comparison 
with that of non-graduates. It is noticeable that only about one third 
of the number had married, and one third of these had not given birth 
to a child. The report unfortunately only comprises 54. Go per cent 
of college graduates, as the remainder did not answer the circulars 
addressed to them. The statistics, therefore, can only be considered 
approximately accurate. 






THE CAUSES OF GYNECOLOGICAL DISEASES. 35 

water, acid, or astringent injections used to destroy the 
vitality of the semen, or the various mechanical measures 
to prevent the entrance of the spermatozoa into the ute- 
rine canal. The injurious effects of such repeated in- 
jections, when the generative organs are excited and 
congested, must be apparent to every practitioner. 
Very many seek to rob Nature of her due by with- 
drawal before completing the sexual act. This tends 
to produce a nervous erethism and chronic congestion. 1 
It thus becomes a fertile cause of disease, and is prac- 
tised in ignorance of the consequences. Nature's laws 
may be infringed, but sooner or later she demands a 
heavy penalty. 

The induction of abortion, the murder of a child by 
its parent, is unquestionably the source of many of the 
diseases which come to the gynecologist for treatment. 
Its pernicious effects are so plainly evident to every 
physician, it needs no further comment. Lack of care 
during and after parturition is more often the fault of 
the doctor than of his patient. Meddlesome midwifery 
is practised, a ruptured perineum is not sewed up, he 
neglects to inquire after the various functions, and 
ascertain for himself that they are properly performed 
after delivery. The patient may move about too soon, 
and over- exert herself in various ways. She may be 
subjected to coitus early, which never should take place 
during the three months after delivery. Excessive 
venery and too frequent childbearing are also causes 
of much subsequent trouble. 

It may not be out of place to mention here what is, 
to say the least, a great mistake, and a positive wrong 

1 Goodell, Lessons in Gynecology, p. 560, 1890. 



36 THE CAUSES OF GYNECOLOGICAL DISEASES. 

to our patients. Man)- a physician has professed to 
understand and treat cases of uterine disease, of which 
in reality he knew nothing. Two reasons seem to ac- 
count for this : first, a desire to make money out of 
the case ; secondly, the fear lest his patient should not 
think him skilful if he sent her to some one better 
informed on the subject. In consultations some doctors 
seek to consult with one who is sure to agree with 
them, no matter what the treatment has been, rather 
than one who might advise differently, and aid them 
in the treat incut of the case. This may seem harsh 
judgment on the profession, but such instances are 
not infrequently observed. The practice of medicine 
should be for the good o\' the patients, and above such 
mercenary, selfish motives. 

Marriage, and especially childbearing, apparently 
confer a certain amount of protection against some 
disorders of* the climacteric, particularly the growth of 
fibrous tumors and mucous polypi, if we accept the 
views of Dr. Emmet, 1 whose observations and statistics 
differ widely from those of most Continental author- 
ities, though singularly in accord with the theory of 
Cohnheim. 2 On the other hand, epithelioma of the 
cervix is seldom seen in the sterile, and with few excep- 
tions is associated with laceration of the cervix uteri. 
Cancer of the breast is much more common in married 
than single women, 8 and more frequent among those 
who have than those who have not nursed their chil- 
dren. 4 Nature seems to have ordained that the cycles 

1 Principles mid Practice of Gynecology, p. 548, 1884. 

2 Vorlesungen iiber Allgemeine Pathologic, Berlin, 1877. 

3 Gross, Tumors of the Breast, p. -280. Am. Cyclop.. Gyn., Vol. IT. 

4 Billroth, Diseases of the Female Mammary Glands, p. 132. 






THE CAUSES OF GYNECOLOGICAL DISEASES. o< 

of ovulation and menstruation should be occasionally 
interrupted and held in abeyance, and that the progres- 
sive and regressive changes in the uterus during its 
growth and involution should be essential to the health 
of women. 

The question of marriage with existing uterine 
disease not infrequently demands our consideration. 
There seems to be a feeling among the laity, that ' ' she 
will be all right when she gets married." In the great 
majority of cases this is quite the reverse, and the 
patient's complaints are increased instead of relieved. 
There are, however, some few conditions which are 
improved or cured by pregnancy and childbearing, 
such as the so-called obstructive dysmenorrhoea, and 
various displacements of the uterus. In the latter class 
of cases, it is very often the best remedy. Where the 
menses are a little irregular in time and quantity, the 
marital relations will sometimes regulate them. The 
various forms of hysteria, and all inflammations of any 
of the pelvic organs, are likely to be increased. Girls 
who have reached the age of twenty without any sign 
of the menstrual flow should be examined to ascertain 
the cause. It may depend on defective development, 
and conception will not be possible. If the marriage 
takes place under such a condition, both parties ought 
to know there will be no offspring. Only a short time 
ago I was consulted in a case of this kind, where the 
young woman had married, hoping it might bring on 
the menses, and conception result ; but all to no purpose. 

Fibroid tumors, which are rare in young women, 
sometimes raise the question of marriage. Unless the 
growth be very small, marriage should be distinctly 



38 THE CAUSES OF GYNECOLOGICAL DISEASES. 

forbidden till after the tumor is removed. The in- 
creased irritation and congestion consequent upon the 
new relations would tend to favor its growth. Should 
pregnancy ensue, delivery might be attended with 
serious complications from dystocia, or post-partum 
hemorrhage. Fibroid tumors have but little vitality, 
and the pressure to which they are subjected in labor 
is liable to cause their death, disorganization, sloughing, 
and as a consequence puerperal septicaemia. I have in 
mind, while writing, the death of a young woman from 
this cause. 

Young women in whose family there is very distinct 
and decided hereditary disease, such as cancer, tuberqi- 
losis, or insanity, for two or three generations back, 
should not marry. Not only will they bestow a fearful 
legacy on their offspring, but pregnancy and child- 
bearing very decidedly favor the development of these 
diseases, particularly the two first mentioned. 

The physician is sometimes asked regarding the 
marriage of relatives. 1 There has been a false alarm 
among the people and many of the profession concern- 
ing it. Idiocy, deformity, albinoism, sterility, and 
especially deaf -mutism, have been attributed to it. All 
the evidence which has been accumulated by the most 
painstaking care is to the contrary. The offspring of 
such marriages are subject to the laws of heredity as 
seen in other marriages. Peculiarities of either parent 
are often transmitted to the child, and should both the 



1 Those interested in the subject will find it ably presented, with 
full bibliography, in The Marriage of Near Kin, by Alfred Henry 
Huth, 1SS1, and more concisely by C. F. Withington, Reference Hand- 
book of the Medical Sciences, Vol. II., p. 272, 18S6. 



THE CAUSES OF GYNECOLOGICAL DISEASES. 39 

parents possess the same peculiarities, the child is doubly 
liable to receive their impress. Tendencies for either 
good or evil thus become intensified in the child, and if 
scrofula, for instance, exists in both parents, it is twice 
as likely to appear in some form in the child as if only 
one parent were affected. Consanguineous marriage is 
not in itself a true cause of deaf-mutism, but the 
numerous instances in which deaf-mutism follows such 
marriages are to be considered as cases of heredity. 1 

A lady sometimes asks herself whether it be really 
necessary for her to consult a physician for diseases 
peculiar to her sex. While the intelligent study of the 
following pages will make other than home treatment 
quite unnecessary for many women, there are cases 
which need the careful attention of a well-educated and 
skilful physician. While the writer would regret to 
interfere with the established practice in any family, he 
feels compelled to write that a careful prescriber of 
homoeopathic remedies, who makes a correct diagnosis 
of a case, will usually succeed far better than his neigh- 
bor in the allopathic school, and, what is much more 
important to the patient, will sometimes save her from 
the surgeon's knife. This is understated rather than 
overestimated, as he desires that no reader of this book 
shall find any but reliable and trustworthy information. 
His statement is based on a long acquaintance with the 
operations and methods of the best operators and hos- 
pitals in Europe and America, and on that familiarity 
which comes from actual residence among them, besides 
an extended personal experience and impartial observa- 



1 Edward Allen Fay, Reference Handbook of the Medical Sciences, 
Vol. II., p. 367, 1S86. 



40 THE CAUSES OF GYNECOLOGICAL DISEASES. 

tion. As a general rule, it may be stated that a physician 
should be seen and an examination made if, in spite of 
carefully following the directions in this book, a lady 
suffers from any of the following symptoms : pain in 
the pelvis ; severe and continued backache ; much bear- 
ing down ; profuse leucorrhcea, especially if it be offen- 
sive or watery and causes smarting ; much loss of blood 
either from too frequent or excessive menstrual period ; 
very painful menstruation and progressive enlargement 
of the abdomen. 






CHAPTER IV. 

PUBERTY AND THE CLIMACTERIC PERIOD. 

The advent and close of the menstrual life of a 
woman are so often attended by phenomena peculiar to 
these periods, and distressing to the patient, that a brief 
consideration of them may not seem unnecessary. 

Puberty is the milestone which marks the transition 
from girlhood into womanhood. During it the sexual 
organs undergo development, and menstruation com- 
mences. With the climacteric period, or change of 
life, these conditions are reversed ; the sexual organs 
atrophy, and the menstrual discharge ceases. Both 
these periods are influenced by climate, heredity, and 
habits of life. In very warm climates, the menses 
appear much earlier than in very cold countries. In 
some families there is an hereditary tendency to men- 
struate very early or late in life, and for the discharge 
to be scanty or profuse, which must be considered in 
forming an estimate of the normal condition. It is 
apparent, therefore, that no definite age can be assigned 
as the normal time for the appearance, cessation, dura- 
tion, or the quantity of the menstrual discharge. The 
establishment of the flow, however, is more rapid and 
constant than the period of its cessation. The average 
age of its appearance is fourteen years and two months ; 
of cessation, between forty-two and forty-five years ; 
and of its duration, four days and a half. The 
quantity varies so much with different individuals, that 



42 PUBERTY AXD THE CLIMACTERIC PERIOD. 

it is best considered normal so long as no ill effects of 
any kind are experienced in consequence. 

At puberty the entire system feels the great change 
that is taking place ; not only are there active growth 
and local development, but there is also called into play 
a remarkable amount of nervous energy. This is very 
largely due to the intimate connection of the ovaries 
with the sympathetic nervous system ; hence it is not 
uncommon for chorea, hysteria, or even epileptic 
spasms to appear at this time, not to mention the 
general condition of nervous erethism or excitement. 
With the establishment of the menses, aided if ne 
sary by proper medication, these symptoms usually 
disappear. 

Menstruation, which is characterized by the period- 
ical discharge of blood from the female genitals once in 
twenty-eight days, depends on the presence of the 
ovaries, and is supposed to coincide with the rupture of 
a Graafian follicle. It therefore marks the childbear- 
ing period in women, though instances are recorded of 
impregnation before the first menses have appeared. 
The flow of blood comes from the uterine cavity. The 
superficial and glandular epithelium of the modified 
mucous membrane lining the cavity undergoes fatty 
degeneration, once a month, disintegrates, and is cast 
off, leaving the capillaries exposed and readily ruptured, 
causing the discharge of blood. The blood pressure in 
the capillaries and the congestion of the pelvic organs 
being relieved, the flow ceases and the lining mem- 
brane of the uterus is reproduced by the proliferation 
of cells, which were beneath the former or superficial 
layer. 






PUBERTY AND THE CLIMACTERIC PERIOD. 43 

At the climacteric period the change is retrogres- 
sive. The Graafian follicles no longer ripen and cast off 
ova. The menses become very irregular, and -finally 
cease to appear. While the duration of this period is 
very variable in different persons, it commonly lasts 
from two to four years. As might be expected, 
nervous derangements are very common, especially 
those of the vaso-motor system. The organism seems 
to contain a superabundance of blood, and the patient 
suffers from congestive headaches, impairment of 
memory, severe flushings like hot water running over 
her; she becomes over-anxious, and is easily worried. 
Besides this, nutrition may become perverted, leading to 
the development of myomas (fibroid tumors) in the 
unmarried or sterile, and more commonly cancer in 
fruitful women, when a severe laceration of the cervix 
uteri is a focus of irritation. Malignant disease may 
develop in either, if there is an element of heredity. 
Obesity is of common occurrence. Although this 
-change of life" is beset with many ailments, chiefly 
mental, and various neoplasms are far more likely to 
develop then than at any other time, the patient will, 
as a rule, enjoy good health afterwards, if she has taken 
proper care of herself during the climacteric. 

Proper hygiene will do much to relieve the various 
complaints of women at these periods, which mark the 
rise and decline of their greatest physical vigor. 

The periodical losses of blood to the system at 
puberty, and the demands for increased nutrition, 
require hearty food in abundance. Meat, milk, and 
eggs are important articles of diet. Fresh air, sunshine, 
and exercise are all necessary to the best physic 



44 PUBERTY AXD THE CLIMACTERIC PERIOD. 

development, unless we desire to have our girls grow 
up like bleached celery stalks, and unfit to meet the 
responsibilities of life. Not less important at this time 
is absolute physical and mental rest during the monthly 
flow. If its real value to them in after life could be 
half appreciated, there would be no grudging the time 
seemingly thrown away. 

Many women suffer ill-health as a consequence of 
ignorance of proper care of themselves, as has been 
intimated in the chapter on the causes of gynecological 
diseases. In many instances I have known years of 
suffering and very often painful menstruation to follow 
imprudence in girlhood. No girl can have it too firmly 
impressed on her mind that there are certain things she 
must not do at the menstrual periods if she values in the 
least good health or long life. Good care at the men- 
strual periods is of special importance, particularly 
during the first three, years in which the menses appear, 
as at this time the generative organs are maturing. 

The things to be strictly forbidden at the menstrual 
period are. exposure to cold, either in the shape of 
wetting the feet or skirts, or sitting on stones or cold 
benches ; thin shoes or slippers in the house or out of 
it; exposure to dampness when rubbers will give pro- 
tection ; long walks, going up many flights of stairs. 
hard work of any kind, or severe study : reaching or 
straining, as in moving heavy furniture, or at stool 
when much constipated : dancing is quite out of place 
as well as indelicate at such a time. It should be dis- 
tinctly understood that any one of these forbidden items 
is liable to do serious injury to health, and no excuse 
should break the ban. Comparatively few of them are 



PUBERTY AND THE CLIMACTERIC PERIOD. 45 

ever admissible at any time. Eest two days before 
menstruation and during it is of great importance. 
The consequence of neglecting these things may not 
appear immediately, but are experienced at the next 
period. How many girls suffer ill-health the rest of 
their lives for one foolish act ! 

Taking cold is not so light a matter as is commonly 
considered. The way for consumption is prepared 
most often by constantly taking cold or neglecting 
one's self. It is not enough to guard against ordinary 
exposure to cold air or draughts. The clothing should 
be arranged so that it can be easily adapted to sudden 
changes of temperature, especially on the seacoast. 
The fur coat or jacket is much too warm to be worn 
except for a very few of the coldest winter days, but 
they are not used in such an exceptional manner. 
They are dressy and are worn on days when they cause 
much perspiration and increased liability to cold. 
Using them continually makes the organism tender, and 
then wearing a lighter coat is followed by taking cold. 
A lady should have light, medium, and very heavy 
jackets or furs, and be particular to change them accord- 
ing to the weather, always reserving fur for only the 
very coldest weather, and removing it in the house, if 
for only a few minutes. 

The body is often protected and the limbs neglected. 
Thick shoes, warm stockings, and fleece-lined boots 
buttoning high up or woollen leggins are not to be 
despised. For riding in cold weather, when the limbs 
often become cold, it is a good plan to put on an extra 
pair of heavy woollen drawers, the legs coming a little 
below the knee. These can be large enough to slip 



46 PUBERTY AXD THE CLIMACTERIC PERIOD. 

over the ordinary covering on the limbs, and be removed 
again in the house. It should be remembered that 
warm clothing is important, and also that it is to be 
removed as far as practicable in a warm room, other- 
wise it causes perspiration, or the individual becomes 
accustomed to it, and then derives very little advantage, 
if not harm, from such an incorrect use of warm cloth- 
ing. 

Young ladies who take cold easily often expose 
themselves in their toilet. They dress in a cold room 
and are too long about it, or more often remove all their 
clothing, put on only a thin, cold, cotton nightgown, 
and then jump into cold sheets and shiver till they can 
get warm, besides having the window open on a cold 
night. It would be better for them to put on a warm 
vest in addition to a warm nightgown, and be careful 
how the open window exposes them to any draught 
during the night. It is hardly necessary to say that 
while fresh air and open windows are good in their 
way, it is easy to admit too much air ; and when a person 
has a cold it is better to ventilate a room from the hall 
or an adjoining chamber than to have a window open 
in the sleeping-room. Whenever a woman has occasion 
to leave the bed at night, she should invariably put on 
slippers and a warm woollen wrap. Going about the 
room barefoot is taking considerable risk. 

How many girls surfer from colds and ultimately 
from chronic catarrh, a most loathsome disease, because 
they will not wrap up their heads or necks in cold 
weather ! Fashion and good looks have been the ruin 
of many. The same is true of wearing evening dres- 
low necks and short sleeves, without warm wraps, or 



PUBERTY AXD THE CLIMACTERIC PERIOD. 47 

cooling suddenly after dancing. The value of health 
or even life is never realized till shattered or lost. It is 
interesting to note that catarrh is almost unknown 
among Quakeresses, which is due, doubtless, to wearing 
a bonnet protecting the head from cold. 

Another cause of ill health in girls and women is pro- 
longed retention of urine. A glance at the anatomical 
plate (opposite page 25) is enough to show how a full 
bladder lifts up the uterus, so that slight exertion is suffi- 
cient to tip the uterus backwards where it will remain 
till replaced by the physician, after possibly years of suf- 
fering, as the immediate effects of such a displacement 
are not observed or are attributed to something else; and 
the dreaded examination is postponed as long as possible. 
It should be the rule for a woman to obey the calls of 
nature at once, and to urinate every four hours. 

Ladies often are inconvenienced while travelling by 
soiled menstrual napkins. Instead of the old-fashioned 
linen towels, I can recommend pads of wood wool, 
which are very absorbent, cheap, and can be destroyed 
after using them. 

Cleanliness is always important. A full bath should 
be taken after each monthly period, and in addition, 
a married woman ought to syringe out the vagina. 
This passage needs cleansing daily when leucorrhcea 
(whites) is present. A teaspoonful of borax in a quart 
of lukewarm water is excellent for this purpose. 

The hot-water vaginal douche is quite different as 
ordered by physicians for inflammatory or congestive 
diseases of the pelvic organs. Six quarts of water at 
not less than 110° Fahr. are employed. In some cases 
it answers to sit over the water-closet or chamber if 



48 



PUBERTY AND THE CLIMACTERIC PERIOD. 



the douche is taken chiefly for cleansing purposes. 
This is not a good position, and not nearly as much 
benefit will be derived from it sitting up as when 
lying down. The hips should be elevated above the 
shoulders, and a douche-pan used to receive the water. 
If the pan tilts up on the mattress from the weight 
of the body, place a lapboard beneath the pan to give 




Fig. 1. Baker's Douche Pan. 



Fig. 2. South\vick'< modification, to 
avoid tilting. 





Fig. 3. Keynold'ri Siphon Bedpan. 



Fig. 4. Reservoir or Pail 
lor Vaginal Douche. 



it a better support. The pail and one of the pans shown 
in Figs. 1, 2, 3, and 4 are good examples of what is need- 
ed. This hot-water douche will do no harm, and will 
relieve materially the aching, bearing-down sensations 
which are so distressing to many women. It is also 
valuable to arrest excessive flowing, when it must be 
taken at about 115° Fahr., but it must not be em- 



PUBERTY AXD THE CLIMACTERIC PERIOD. 49 

ployed indiscriminately for this purpose. It needs to 
be used every day. Cold vaginal douches are dangerous, 
and should never be used if a woman values her health. 

Medicated douches are often helpful after the large 
hot-water douche. A pint of equal parts of Hama- 
melis and water slowly injected is often soothing for 
aching in the ovaries. A teaspoonful of the compound 
tincture of iodine and four tablespoonfuls of glycerine 
are excellent for chronic inflammation of the uterus. 
The iodine must be measured by pouring a teaspoon- 
ful of water in an empty bottle, emptying it out and 
pouring in an equal amount of iodine direct from the 
bottle of iodine. The reason is that iodine will destroy 
metals. The application of the preparation of iodine 
and glycerine is made by using a hard rubber piston 
syringe, and half the above quantity at a time, i. e., 
half a teaspoonful of iodine and two tablespoonfuls of 
glycerine, twice a week. Some burning and smarting 
may follow the application for a few minutes. Two 
teaspoonfuls of the aqueous fluid extract of Hydrastis 
and an equal amount of the dark extract of Pinus 
Canadensis added to a pint of lukewarm water is 
most excellent for leucorrhcea. It should be used 
daily. It stains indelibly, and ladies must look out 
accordingly for their clothing. 

Hot sitz. baths, i. e., hip-baths, are also used for 
conditions similar to the hot-water vaginal douche and 
for delayed or scanty menses. The woman merely 
sits for half an hour in a small tub with the hot 
water coming up over the hips. 

Foot-baths are employed in domestic practice more 
than sitz baths or hot -water vaginal douches. The 



50 PUBERTY AND THE CLIMACTERIC PERIOD. 

best time to take a foot-bath is in the evening. Select 
a warm room and a chair with a high seat ; throw a 
heavy blanket over the chair ; undress ready for bed, 
and have a second person bring in a pail or foot-bath 
tub half full of very warm water, with a heaping 
tablespoonful of mustard thoroughly stirred in it, also 
a pitcher of hot water and a couple of Turkish towels. 
The person taking the foot-bath sits in the chair, 
folds the blanket over her, and puts her feet in the 
mustard and water. The second person rubs the feet 
and limbs, gradually adding hot water from the pitcher, 
keeping the bath as hot as can be endured. This is 
continued for fifteen or twenty minutes, when the 
feet are taken out, a towel hastily wrapped around 
each foot, and the patient gets into a warm bed im- 
mediately and covers up warm without further drying 
or rubbing ; in an hour the towels can be removed 
from the feet. The chair should be placed near the 
bed, so there will be no delay in going to bed. A 
hot-water bag to the feet, and drinking freely of hot, 
weak lemonade will aid the action of the foot -hath. 
Suppression of the menses from taking cold, delayed 
menstruation, and painful menstruation with a scanty 
now are well-known reasons for using the hot foot- 
bath. Cold foot-baths are apt to do injury, and no 
woman should use them. 

The hy<jiene of the climacteric is at once suggested 
by the patient's condition. Very little beef is to be 
eaten when there are symptoms of local congestion, 
ouch as rush of blood to the head. Eggs, fish, poul- 
try, game, and vegetables are in order. If there is 
a tendency to obesity, which the patient desires to 






PUBERTY AND THE CLIMACTERIC PERIOD. 51 

counteract, all food containing much starch, sugar, or 
milk should be avoided, and water drank sparingly 
if urea is in excess ; fruit, such as oranges, grapes, 
cherries, and berries, may be eaten ad libit am, if they 
do not disagree with the patient. Plenty of exercise 
in the sunshine amd open air is always advisable. 
Pleasant society, cheerful surroundings, and enough 
to do merely to occupy the time without undue 
fatigue, will materially relieve the mental symptoms. 

Having briefly reviewed the subject of this chapter 
in a general way, it may be well to consider here in 
more detail some of the anomalies characteristic of 
each period of life. 

The first menstrual period, indicating that the girl 
will soon become a woman, as well as her capacity 
for childbearing, is often preceded by congestive symp- 
toms, such as headache, dizziness, nosebleeding, general 
nervousness, and not uncommonly by a slight whitish 
discharge of fluid or mucus from the genitals. Some 
girls mature very early. I have known two sisters who 
began to have regular periods before they were ten 
years old. Such instances are rare exceptions to the 
general rule stated in the beginning of this chapter. 
Precocious girls, having an old appearance, whose 
breasts become prominent, and whose hips are broad, 
are likely to menstruate much earlier than the average. 
Under all circumstances, mothers should acquaint their 
daughters with the nature of the discharge, and ex- 
plain to them the necessity of caring for themselves. 

It is highly important for every girl to have con- 
siderable freedom from mental or physical labor from 
the time of the appearance of the first symptoms 



52 PUBERTY AXD THE CLIMACTERIC PERIOD. 

preceding menstruation till the flow is fully established, 
and regular every month. Neglect of this precaution 
is often the cause of painful menstruation, and much 
suffering for the rest of the girl's menstrual life. 

The period is seldom established at once, but is 
often irregular, four or five months may intervene 
between the first and second periods, or even after- 
wards. If the girl is otherwise well, it is no cause 
for alarm. Use no forcing medicines. Observe the 
diet and hygiene already recommended, and the girl 
will come out all right, though it may be a couple 
of years before the periods are fairly regular. 

Chlorosis. 

Chlorosis, or green sickness, is a disease found in 
girls at or near the age of puberty, the most charac- 
teristic feature of which is the anaemic, or pale ap- 
pearance of the patient. Indeed, the resemblance to 
anaemia is sometimes so close in practice that the 
dividing line cannot be drawn between them. It gives 
a better picture of the disease to call it a special form 
of anaemia. Dr. Flint states that there is a reduction 
in the percentage of hemoglobin of the red blood cor- 
puscles, without a corresponding decrease in the number 
of the latter ; and Yirchow lays much stress on the 
arrested development of the vascular system, particu- 
larly the aorta. The microscopical examination shows 
an abnormal paleness of the red elements, without 
much diminution of their number ; sometimes there is 
a relative increase of the leucocytes. There are fre- 
quently poikilocytes and less microcytes and megalo- 






PUBERTY AND THE CLIMACTERIC PERIOD. 53 

blasts. 1 Chlorosis is believed to have a nervous origin, 
as its appearance so often dates from some impression 
on the nervous system, from the frequency of nervous 
symptoms, hysteria, etc., in its early development, 
and, finally, because those remedies which are most 
effectual in combating it are particularly adapted to 
the treatment of nervous diseases. It is worth while 
to remember that it not uncommonly follows an 
unfortunate love affair. Much stress is laid by some 
physicians on the importance of a lymphatic consti- 
tution, and scrofula, as a predisposing cause. 

The symptoms of chlorosis are quite marked. The 
three, most important ones are, absence of the menses 
or diminished flow ; great pallor of the skin, having 
a waxy or sometimes greenish hue, together with the 
noticeable feature that the girl does not lose flesh. 
The extreme pallor of the skin, the pale gums, tongue, 
and lips, together with the puffy, pale face and white 
ears at once suggest the disease. Such patients are 
often nervous, complain of neuralgic pains, palpitation 
of the heart, chilliness, prostration, weight -in the 
chest, inability to work, and deranged appetite, a 
fondness of chalk, slate pencils, or pickles is not 
uncommon. There are often associated with these 
symptoms others which denote much disturbance of 
the stomach, particularly ulceration of the stomach. 
These are pain after eating and localized sensitiveness 
of the stomach. Hemorrhage from the stomach does 
not occur in half the cases of ulceration of that organ, 2 



1 Jaksch, Klinische Diagnostik, p. 28, 1889. 

2 Ewald, Yerdauungskrankheiten, p. 248, 18S9. 



54 PUBERTY AXD THE CLIMACTERIC PERIOD. 

and it is a serious mistake to count on that as a 
decided symptom, as some writers affirm is necessary. 

I have been much interested in the simple treat- 
ment of such cases by the distinguished Prof. Oser, 
and can recommend it from personal observation of 
many of his cases in the Vienna hospital. He insists 
on absolute rest in bed. The patient is not allowed 
to sit up, or even talk. She receives no food, except 
iced milk in small quantities, at short intervals, jledi- 
cine is rarely given. Many cases are practically cured 
hi two weeks, i. e., are well enough to be about with- 
out discomfort, though of course it will not do to 
indulge the appetite freely in all kinds of food and 
drink. The disease is generally easily cured if not 
grafted on a scrofulous constitution ; but it exhibits 
little if any tendency to spontaneous cure, and may 
therefore last a number of years without treatment. 

Hygiene is of great advantage in the treatment of 
chlorosis. Sleep, fresh air, and sunshine, plenty of 
milk and sweet cream are quite as helpful here as in 
many other diseases. The products of the frying pan, 
melted butter, and the time-honored doughnut are to 
be sedulously avoided, and the free use of beef, poultry, 
and eggs is to be cultivated. A good hair mattress 
is far better to sleep upon than a feather bed, while 
a daily bath in slightly cool salt and water, followed 
by vigorous friction in a warm room, will do much 
to improve and stimulate the skin. Tea, coffee, choco- 
late, and highly seasoned food should be discarded. 

Therapeutics. 

In the vied iced treatment of this disease immediate 
effects are not to be expected, and it is often a matter 






PUBERTY AXD THE CLIMACTERIC PERIOD. 55 

of a few weeks before complete recovery takes place. 
The following are the more common remedies: — 

Calcarea carb. 9 * trit. tablets, a tablet night and 
morning, is a good constitutional remedy where the 
patient is scrofulous, fat. flabby, and subject to enlarge- 
ments of the glands : if there be a craving for pickles, 
chalk, etc. : if she takes cold easily, has acid mouth 
and stomach, complains of much difficulty of breath- 
ing, swelling of the extremities or leucorrhoea ; if 
she cannot bear tight clothing about the waist ; if the 
head and upper part of the body or the feet sweat 
profusely and easily, and the feet feel cold and damp 
in consequence : also, if there is a fear of going crazy, 
or that people will think her so. This last symptom 
is not likely to be present. 

Ferrum is the best remedy for the majority of 
cases, but for this very reason it is too commonly 
prescribed as a routine practice to the injury of the 
patient when it is not indicated. In domestic practice 
the writer can recommend the advice of a French 
physician who employs Ferrum 30 dil. a dose night 
and morning for a week, waits a few days to observe 
the effect, and then takes it for another week. Should 
improvement be observed, it is best to continue the 
same preparation. If there be no improvement in a 
fortnight, then a stronger preparation can be tried to 
advantage, if this remedy still seems indicated. This 
should be the Citrate- of Iron and Strychnia 2 * trit.. a 
powder the size of a small bean, half an hour before 
each meal. It is especially indicated by extreme pallor 
of the face, with occasional sudden red flushes ; with 
dizziness : ringing in the ears : palpitation of the heart ; 



56 PUBERTY AND THE CLIMACTERIC PERIOD. 

difficult breathing ; chilliness and a little feverishness 
towards evening ; great debility ; want of appetite ; 
nausea, and pale lips. 

The imported Bland's 21 ills are another excellent 
form of iron, and in some cases succeed where the 
above preparations fail. Be particular to obtain the 
imported pill with the name Blaud stamped on them. 
Take two pills before each meal, and when better take 
only one. Improvement will be seen in a fortnight 
if at all. Buy them in the original bottles, containing 
a hundred pills, with the wrapper unbroken. This 
is important, as inferior pills are often substituted and 
called " just as good." 

Ignatia 9 * disks, a disk before each meal, I have 
found very helpful when the disease was due to men- 
tal or emotional causes, as an unfortunate love affair. 

Pulsatilla** disks, a disk before each meal, is highly 
praised by some for this disease when associated with 
menstrual irregularities or suppression. Girls of a 
mild, tearful disposition, also if they are subject to 
styes on the eyelids. When the disease has been 
caused by exposure to cold or dampness, and is at- 
tended by frequent attacks of pain in one side of 
the head, shooting to the ears and teeth ; pain pres- 
sive or snapping in character, or changing its location 
suddenly ; bad taste in the mouth ; difficult breathing ; 
shortness of breath ; palpitation of the heart ; looseness 
of the bowels, no two movements alike ; nausea and 
vomiting ; creamy or milky, bland leucorrhcea and 
great fatigue, especially in the legs, which go to sleep 
easily ; pressure and sometimes pain low down in the 
abdomen ; better in the open air ; worse in a close and 









PUBERTY AND THE CLIMACTERIC PERIOD. 5< 

warm room ; first menses delayed ; menses irregular 
from exposure to cold or wet. 

Sepia 6 * tablets, a tablet before each meal, if Pul- 
satilla fails. The patient for Sepia is apt to have much 
bearing down in the pelvis ; yellow or milky excoriat- 
ing leucorrhoea, and a sensation of sinking or empti- 
ness of the stomach ; eruptions on the skin, which 
usually itch ; yellow spots or patches on the face, and 
putrid, offensive urine, with a pinkish sediment adher- 
ing closely to the vessel. 

Arsenicum and Sulphur are also good remedies, but 
are not so commonly used. A French author reports 
excellent success with Zingiber** disks, a disk night 
and morning. The remedy is well worthy of a trial, 
should those mentioned prove insufficient. 

The headaches which sometimes attend the men- 
strual period are very distressing, but fortunately are 
usually curable if they are not hereditary, and the causes 
can be removed. Prominent among the latter are 
plethora, ovaritis, and uterine displacement, besides the 
usual causes of headache when it is independent of the 
monthly flow. Too much stress cannot be laid on the 
importance of removing any abnormal condition of the 
sexual organs before a cure can be promised. 

The headaches are of various types, and the same 
remedies for the more common forms of headache are 
applicable here, according to the symptoms. Not only 
is it necessary to repeat the medicine at short intervals 
during the attack till there is improvement, but also to 
give it at intervals afterwards, to avoid or break up the 
tendency to recurrence of the paroxysms. In obstinate 
cases, some constitutional remedy, such as Galea rea 



58 PUBERTY AND THE CLIMACTERIC PERIOD. 

carb., Graphites, Natrwm mur., Sepia, Silicea, or Sul- 
phur must be carefully selected, and used persistently 
for months if necessary, before the patient can be 
cured. 

Therapeutics. 

Unless otherwise mentioned, use the following 
medicines in the 3x preparations, a disk, a tablet, or a 
powder the size of a pea, once in half an hour during 
the headache, and night and morning in the interval 
between the attacks. 

Aconite. — An admirable remedy for violent con- 
gestive headache due to sudden suppression of menstrual 
discharge; after fright, or sudden exposure t<> cold. 
Restores the menses of plethoric women after their 
suppression from any cause. Congestion of brain. 
anxiety; face hot and red, less often pale and red 
alternately ; arteries in the neck pulsate strongly ; rest- 
lessness, with cerebral congestion ; pulse full, strong ; 
skin dry and hot; sometimes chilly sensations arc 
present. The pain in the head is likely to be severe 
when Aconite is indicated, with a full heavy feeling as 
if everything would push out of the forehead, or a burn- 
ing headache, which might be compared to the brain 
being agitated by boiling water; dizziness is common, 
and the scalp may be sensitive. 

I Belladonna. — Severe throbbing, pulsating headache 
before or during the menses ; also, if this severe throb- 
bing or stabbing pain folloics a sudden suppression of 
the floiv in plethoric subjects. The face is red and hot, 
and not infrequently there is much weight or bearing 
down in the pelvis. The pain in a headache requiring 



PUBERTY AND THE CLIMACTERIC PERIOD. 59 

the use of Belladonna is rather more severe than the 
headache calling for Aconite. It is apt to be worse 
near the close of the afternoon, or after midnight, from 
noise, motion, moving the eyes, which are sensitive to 
the light, and pupils dilated, coughing, the heat of the 
sun, near a hot stove, and in hot weather, and some- 
times from lying flat down, while a half- recumbent posi- 
tion may relieve it ; pressing strongly on the forehead 
sometimes relieves it. The pain is apt to come and go 
quickly, or jerk severely on walking or going quickly 
upstairs. The sense of smell is unusually acute, and 
the mouth is apt to be dry. 

Cactus has been commended for pressive headache 
on the top of the head, resulting from too profuse flow- 
ing, also for a similar headache at the change of life, 
better from pressure, worse from noise and light, sensa- 
tion of constriction and palpitation of the heart. 

Cimicifuga. — Vertigo, fulness and dull aching on 
top of the head, dull aching especially in the back of 
the head, with sense of soreness in that region ; intense 
aching, sore pain in the eyeballs ; headache worse dur- 
ing the menses from motion and indoors, better in the 
open air ; pains shooting sideways in the pelvis, and 
upwards from the ovaries ; tenderness over the uterus, 
and irregular, delayed, or suppressed menses ; hysterical 
or epileptic spasms at the time of the menses; ner- 
vousness increased during menstruation. The woman 
may feel grieved, sigh a good deal, and be subject to 
rheumatic pains or sore spots in the muscles, also to 
nervous shuddering. It sometimes is helpful for head- 
aches in the nape of the neck, caused by displacements 
of the uterus. In this class of cases no remedy will 



60 PUBERTY AND THE CLIMACTERIC PERIOD. 

cure till the cause of the trouble has been removed by 
properly treating the displacement. 

Cocculus is highly esteemed for menstrual headache 
in hysterical women, when the head feels empty and 
hollow, and there is inclination to vomit with much 
nausea, especially when rising up, riding, or swing- 
ing, and with flatulent distention of the abdomen ; much 
confusion in the head, increased by eating and drinking. 
Headache worse in the open air, better in a warm 
room, from rest and lying down ; menses too early, with 
colicky pains ; knees weak ; feet and hands alternate in 
going to sleep ; soles of feet go to sleep while sitting. 

Cuprum. — Spasmodic dyspnoea before the men 
also rush of blood to the head, intense pain extending 
from the neck into the occiput : cramps in the abdomen, 
with nausea and vomiting ; headache begins twelve t<> 
twenty-four hours before the flow, and is better when 
the latter is established. 

Gelsemium. — The writer has had prompt results 
from the lx or 2x where it failed in higher potencies. 
If good is to follow, relief is experienced after two or 
three doses. As a rule, it needs to be re-enforced by 
some constitutional remedy given in the intervals 
between the monthlies. Before or with supj tressed 
menses, congestion of blood to the head; bruised feeling, 
or severe pain in the head and face, of a neuralgic or 
spasmodic type ; vertigo, blurred vision, nausea and 
vomiting ; profuse emission of clear urine, which relieves 
the headache; sometimes a feeling of stupor or drowsi- 
ness ; less frequently chilliness precedes the headache, 
which is worse from lying down. Trembling and weak- 
ness, eyelids are heavy. 



PUBERTY AND THE CLIMACTERIC PERIOD. 61 

| Glonoine. — The chief remedy for sudden suppres- 
sion of the menses in plethoric, full-blooded women, or 
with scanty menses, accompanied by intense cerebral 
congestion ; violent throbbing headache, increased by 
every motion ; head feels full, face red, pulse full and 
quick.; throbbing from neck extending into occipital 
region. Often indicated in cases with albuminuria. 
Terrible crushing, sinking Jieaclaehe. The pain is not 
as severe as in the headache requiring the use of 
Belladonna, which resembles the Glonoine headache. 
The headache requiring Glonoine shows more conges- 
tion of the brain than that of Belladonna. The head 
feels full and very large; jiaiidess throbbings in it, 
which are regular like the pulse : any motion of the head 
can hardly be endured ; headache or throbbing in the 
head instead of the menses ; if the headache originated 
from exposure to heat of the sun, wine or other stimu- 
lants increase the headache. Headache usually better 
at night and in the open air. The Belladonna headache 
is worse in the latter part of the afternoon and again 
after midnight. 

Graphites. — A good constitutional remedy ; menses 
scanty or delayed; flow often pale; swelling of the 
ovaries, without much local inflammation ; violent head- 
ache with eructations and nausea during the menses, 
or tearing pain in the epigastrium at this time ; con- 
stipation, stool dark, large and knotty, half digested 
and offensive ; apprehensive, sad, and despondent moods ; 
numb pain in the head, or a constrictive feeling in the 
back part of it ; falling off of the hair ; dry mucus in 
eyelashes and inflamed margins of eyelids ; moist, sore 
places behind the ears exuding a watery, sticky fluid ; 



62 PUBERTY AND THE CLIMACTERIC PERIOD. 

moist blotches, or itching pimples on the skin, especially 
about the chin and around the mouth, soreness and crack- 
ing of the lips and nose as if she had a cold. Sense of 
smell very acute, cannot endure the smell of flowers, 
nose sore inside, sensation of a cobweb on the face ; 
dislikes meat and sweet things ; urine turpid, depositing 
a white sediment ; external genitals itch before menstru- 
ation. This remedy is best adapted to corpulent women 
with large abdomens and unhealthy skins, as indicated 
above. Very many of the constitutional symptoms 
mentioned above may be wanting, and yet a remedy 
be indicated. If all should happen to be present, they 
only indicate the drug more strongly. It is more valua- 
ble as a remedy between the periods t<» prevent head- 
ache than when it really occurs. 

Ignatia. — Severe pressing headache during men- 
struation, with frequent spasmodic yawning, and emis- 
sion of watery urine every few minutes. It is best 
adapted to nervous, hysterical women, who are very 
changeable in disposition, slight blame or contradiction 
easily irritating them ; inconstant, irresolute, impatient 
women • pain either pressive, or like a nail driven out 
through the side of the head ; the head is relieved by 
lying on the painful side, or from changing position ; 
frequent sighing, wants to take a long breath, jerking 
and twitching of the muscles ; headache from coffee, 
tobacco, or alcohol ; worse mornings, from moving the 
eyes, from stooping, and from noise. 

Nat rum mur 20 . — Headache before, during, or after 
the menses, with depression of spirits ; heavy pressive 
pain in the forehead over both eyes ; severe bursting 
headache, also dull, pressive, stupefying headache ; 



PUBERTY AND THE CLIMACTERIC PERIOD. 63 

headache in schoolgirls, especially in the morning ; 
beating headache, or stitches through to the neck and 
chest ; with heat in the head, red face, nausea and 
vomiting before, during, and after the menses ; eves 
give out on using them, and objects become confused ; 
constipation with sensation of contraction of the anus ; 
difficult expulsion of hard, dry, and crumbling stool, 
cracking the skin so that the anus bleeds and aches 
afterward. The patient is apt to be thin and scrawny, 
easily fatigued, subject to itching blotches on the skin, 
more especially to an itching eruption at the margin 
of the hair on the nape of the neck, and to be very 
fond of salt. Tickling in the throat, and coughing, 
causing a bursting pain in the forehead, is an additional 
indication for this remedy, which is not often indicated. 

Pul sat ilia. — Dull, pressive headache, with bruised 
sensation in the forehead, and dizziness at the age of 
puberty before the first menses have appeared, or when 
the flow is delayed and scanty. The patient is depressed 
mentally, and complains of chilliness in the daytime, 
and dry, burning heat, without thirst at night. The 
headache is relieved by pressure, by walking slowly in 
the open air, and by lying down on the back. Worse 
in a warm room. 

Sanguinaria. — Menses at the right time, with scanty 
flow, and severe throbbing headache, extending from 
the back of the head over to the forehead, especially 
the right side; vertigo ; face red and hot, less often pale, 
with disposition to vomit ; eruption on the face of young 
women with menstrual troubles, and especially a scanty 
flow ; headache in paroxysms ; blood rushes to the head 
with whizzing in the ears, and flushes of heat ; head- 



64 PUBERTY AND THE CLIMACTERIC PERIOD. 

ache ivith nausea and chilliness, followed by flushes of 
heat, extending from the head to the stomach; head- - 
ache especially at the change of life. Worse from light, 
noise, and motion ; better from lying quietly in a dark 
room, and after vomiting. 

I Sepia. — One of the best remedies for the radical 
treatment of obstinate cases with the following indica- 
tions : heavy pressive pain in the left orbit and left 
side of the head, with darting pains over the left side 
of the head, better after eating ; morning nausea ; 
sinking, "gone" sensation in the stomach; bearing 
down in thepelvic organs; menses irregular or scanty ; 
sexual instinct increased ; fetid perspiration about geni- 
tals, axillae, and soles of feet ; moth spots or yellowish 
discoloration of the skin; itching, herpetic eruptions. 
The constitutional symptoms are more important than 
those relating solely to the headache. 

Ceded red carl)., Nux vomica, and Sulphur are als<> 
very useful remedies for menstrual headache. 

Toothache is sometimes a distressing complication of 
menstruation. The following are some of the more 
common remedies which are often very helpful. In a 
general way, the medicines are divided according to the 
relation of the pain to menstruation; but such a division 
is not absolute, and a remedy may be given at any time 
if the symptoms indicate it. Give the remedy in the 
third potency, a dose every twenty minutes ; as soon as 
there is a little relief, only give it once in one or two 
hours. 

Toothache before Menstruation. 

Arsenicum is the chief remedy. The pain is jerk- 
ing or throbbing, sometimes extending to the temple. 



PUBERTY AND THE CLIMACTERIC PERIOD. 65 

The teeth feel loose, elongated, sensitive to touch, pres- 
sure, or cold water. The gum may ache and be sensi- 
tive. The pain is worse from lying on the affected side, 
at rest from cold, is not infrequently worse at night. 
The pain is relieved by heat, and sometimes by sitting 
up in bed. If the pain causes considerable prostration 
and the patient feels feverish with cold hands and 
especially cold tips of the fingers, Arsenicum is generally 
helpful. 

Aconite will relieve some cases in which the patient 
is frantic with indescribable pain; throbbing toothache 
from taking cold, burning of the face, and rush of blood 
to the head. It also follows Coffea well when that 
remedy fails to relieve. 

Belladonna is indicated for dull, drawing pain in 
the upper right row of teeth ; also, when the pain causes 
great restlessness, depression of spirits, aching of gums, 
roots of teeth painful on biting, pricking pain in a 
decayed tooth, pain radiating in all directions from a 
tooth, pain worse at night from cold air, from touch, 
from biting hot food, or liquids touching the tooth ; 
pricking the gum till it bleeds or hard pressure on the 
cheeks sometimes relieves the pain. 

Chamoinilla is an important remedy for tooth- 
ache preceding or accompanying menstruation, espe- 
cially in coffee drinkers. The pain causes a great deal 
of irritability and crossness. The tooth feels too long. 
The pain may extend through all the teeth through the 
jaws to the ear, or through the temples to the eyes. 
Most of the pain is on one side, tearing, boring, throb- 
bing, stinging, or jerking in character. The pain is 
worse at night from the warmth of the bed, much worse 



66 PUBERTY AND THE CLIMACTERIC PERIOD. 

from drinking cold water or strong coffee, eating or 
drinking anything warm ; but the pain is sometimes 
relieved by dipping a finger in cold water and applying 
it to the tooth. Pain generally commences after meals. 
Dr. Hering, who made many of these observations, 
remarks : "If the pain is accompanied with great weak- 
ness, particularly in the joints, pain in the articulation 
of the jaw on opening the mouth extending to the teeth, 
Chamomilla will certainly cure." 

Coffea is one of the very best remedies for violent 
toothache, when the patient is almost wild with pain, 
crying and trembling, not knowing what to do, stinging, 
jerking pain, intermitting pressure or pain when chew- 
ing ; pain often relieved by holding ice water in the 
mouth ; teeth feel crowded together, or as if something 
were in them. 

Mercurius protoiodide has been very helpful for 
toothache in a decayed tooth, which is very sensitive to 
the touch and seems to be always in the way; the face 
is often swollen. It is a form of toothache which is not 
likely to be dependent on menstruation, but rather on 
decay of one or more teeth. The pain is rather severe, 
drawing in character, but may assume almost any type, 
aggravated by cold or damp air, eating or drinking any- 
thing cold or warm, and is often worse at night. 

P id sat ilia is best adapted to women of a mild tem- 
perament, whose menstrual periods are usually more 
than four weeks apart and are rather scanty, also to 
those subject to toothache in the spring ; toothache, ear- 
ache, and headache on the same side ; the face is very 
painful, especially the left side extending to the ear ; heat 
in the head and chilliness of the body ; pricking, tearing, 



PUBERTY AND THE CLIMACTERIC PERIOD. 67 

jerking pain, or pain as if the nerve was stretched and 
suddenly let go, allowing it to snap ; pain worse from 
cold water, heat of bed, or warm room; better in the 
open air, and returns on entering a warm room ; worse 
toward evening, when sitting and from picking the 
teeth ; better from walking about and from pressure. 

Toothache during Menstruation. 

Calcarea carb. — See ' ' Toothache during Pregnancy. " 
Chamomilla is a good remedy. The symptoms indi- 
cating it are previously mentioned. 

Laches is. — When the toothache appears during 
menstruation, the less the flow the greater the pain, or 
at the cessation of menstruation. The gums may be 
inflamed and the pain extend to the throat. The tooth- 
ache is worse after warm and cold drinks, after eating 
and awaking, with headache, beating over the eyes, 
stitches in the ears, swelling of the cheek, chills, fever, 
and thirst. The swollen, tender, easily bleeding gums 
are a noticeable complication. 

Toothache after Menstruation. 

Bryonia. — Passionate or obstinate persons, pain 
more often in sound than in decayed teeth, though con- 
tact of the latter with the air may excite pain. Acute, 
shooting, or tearing pain extending to the cheek or ear, 
or from one tooth to another ; pain worse from anything 
warm in the mouth, momentarily relieved by drinking 
cold water ; better in the open air when lying on the 
affected side, and worse lying on the opposite side. 

Calcarea carb. — The symptoms are mentioned in 
"Toothache during Pregnancy." 



OS PUBERTY AXD THE CLIMACTERIC PERIOD. 

Chamomilla. — See symptoms given above. 
Lachesis is a good remedy. See symptoms given 
above. 

Toothache during Pregnancy 

Is an obstinate affection and difficult to cure till preg- 
nancy is over, when the pain disappears of itself. The 
following remedies may prove beneficial, and are worth 
trying. There need be no fear of a miscarriage as the 
result of dental operations, providing they are short and 
not fatiguing to the patient. Visits to the dentist at 
periods in which the menses would occur ordinarily 
should be avoided, as at these times the liability to mis- 
carriage is much increased. 

The symptoms of Belladonna, Bryonia, Mercurius 
protoiodide, and Pulsatilla have been given. 

Calcarea curb. — Pain in decayed teeth or around 
loose stumps, or if a loose tooth causes pain all the time. 
The pain may be of almost any description, and is 
accompanied with swollen, sensitive, easily bleeding 
gums, which may ache and throb. Very important are 
the symptoms : rush of blood to the head, especially at 
night ; pain caused or aggravated by taking cold or a 
draught of cold air ; inability to take warm or cold 
drinks, and the pain may be aggravated by noise. 

Nux moschata. — Women who do not perspire easily 
and who have a cool dry skin. Constant grumbling 
and soreness of the teeth ; pain from taking cold in 
cold, damp weather or night air ; pain worse in going 
hastily up or down stairs, from cold or damp air in 
the mouth, better from warm water in the mouth 
and hot applications. 



PUBERTY AND THE CLIMACTERIC PERIOD. 69 

Aphonia, or weakness of voice, coming on at each 
menstrual period, has been cured by Gelsemium. Dr. 
Bichard Hughes mentions Antimonium crudum when it 
occurs every time the patient is exposed to heat. 

Deafness with the menstrual period, menses scanty, 
hearing better out of doors, has been cured by Kreosote 2 *. 

TJie anomalies of the climacteric period (menopause, 
change of life) may be considered as those of per- 
verted nutrition, such as the development of obesity, 
benign or malignant tumors, and disturbances of the 
vaso-motor system, causing flushings, local congestion, 
etc. Hysteria sometimes appears, and there is marked 
irregularity of the menses, both in time, character, and 
duration of the flow. The hygiene has been described 
in the beginning of this chapter, so there only remain 
for consideration those remedies peculiarly applicable to 
vaso-motor disturbances, which play such an important 
part in the sufferings of the climacteric period. 

When the monthly congestion of the pelvic organs 
and the flowing have permanently ceased, atrophy of 
these structures gradually progresses from year to year. 
Consequently, inflammatory diseases common to the 
menstrual or childbearing age are very rarely if ever 
seen in the post-climacteric period. Uterine fibroids, 
which may have developed, scarcely ever increase after 
the flow permanently ceases, and, as a rule, slowly 
decrease or even disappear. The suffering incident to 
uterine displacement is much relieved ; chronic metritis 
and ovaritis gradually undergo spontaneous cure. Pro- 
cidentia of the uterus, especially if complete, seems to 
be an exception to the rule, and is very seldom bene- 
fited by the " change of life." 



70 PUBERTY AND THE CLIMACTERIC PERIOD. 

Therapeutics. 

Take one dose of the third decimal preparation once 
in six hours, unless otherwise mentioned, and always 
stop the medicine if the symptoms are aggravated by it 
and when improvement has commenced. 

Aconite is more often indicated in the commence- 
ment of the climacteric in robust, plethoric women, 
where there is arterial tension ; pulse quick, full, hard, 
and strong ; patient is timid, anxious, restless, complains 
of vertigo, fulness and heavy feeling in the forehead, 
sometimes nosebleeding of bright red blood, and the 
senses of smell and hearing are morbidly acute. Drs. 
Hughes and Leadam urge the employment of only the me- 
dium or higher dilutions, on account of the great liability 
to produce aggravations with the low attenuations. 

I Amyl nitrite is a most excellent remedy. Flush- 
ings of the climacteric when Lachesis fails ; heat and 
throbbing, with sensation of intense fulness in the head ; 
much throbbing in the ears ; flushing of the face ; chok- 
ing, constricted feeling about the throat. The thirtieth 
potency acts remarkably well for flushings of the cli- 
macteric. 

Argentuni nit. — Dr. C. Hering marks the following 
symptoms : metrorrhagia, with nervous erethism at 
change of life, also in young widows and those who 
have borne no children ; returns in attacks ; region of 
ovaries painful, with pains radiating to the lower part 
of the back and thighs ; memory impaired ; vertigo and 
buzzing in the ears, and general debility of the limbs, 
and trembling ; boring pain in left frontal eminence, or 
dull pressive pain on the vertex, relieved by binding 
something tightly on the head. 






PUBERTY AXD THE CLIMACTERIC PERIOD. Tl 

CaulophyUin. — Dr. Ludlam states that he has 
often prescribed this remedy for post- climacteric ner- 
vous conditions, with excellent results ; attacks of 
"great nervous tension and unrest, with wakefulness, 
and a propensity to work and worry over little things." 
The presence of rheumatism of the smaller joints would 
be an additional indication for it. 

Cimieifuga 2 *. — Restless and unhappy state of mind ; 
the patient feels grieved and troubled, with sighing, is 
irritable, cannot sleep ; vertigo ; fulness and dull aching 
on top of the head ; sinking at the stomach ; menses 
irregular, with increased nervousness and muscular 
twitchings at the time. 

Coffea. — All the senses are very acute; patient 
cannot bear pain ; mind very active, cannot sleep nights, 
on account of thinking ; hears the least sound ; a general 
condition of marked nervous excitement. 

Gelsemiinn lx or 2x is an excellent remedy for the. 
congestive headaches of the climacteric. The attack 
often begins with drowsiness, or perhaps chilliness, 
then severe pain, usually of a neuralgic or spasmodic 
form, sometimes pulsation of the carotids, and accom- 
panied by vertigo, blurred or double vision, occasion- 
ally by nausea and vomiting, and is relieved by the 
profuse emission of watery urine. 

Glonoine has been warmly praised for congestions 
of the head, and flushings limited to the face, also 
for its characteristic headache ; violent throbbing in 
the head, or from neck into the occipital region ; head 
feels full, face red, and the pulse is full and quick. 

II Lachesis. — The chief remedy for flushings at the 
climacteric ; also hot vertex, metrorrhagia, and faint- 



72 PUBERTY AXD THE CLIMACTERIC PERIOD. 

ing at this time ; there is painful distention of the 
abdomen from flatulence, and the patient can bear no 
pressure of the clothes. Not infrequently there is 
considerable irritation from the left ovary, which is 
swollen, indurated, or is the sight of neuralgic pains. 
She wakes in the morning with vertigo and a sense 
of great exhaustion or weakness of the body, and at 
times suffers from headache extending into the root 
of the nose, or, less frequently, one-sided or occipital 
pain, extending into the neck and shoulders, sleepless- 
ness. The patient is nervous, anxious, loquacious, in 
a weakened condition, and feels worse when the dis- 
charges do not appear. 

Sanguinaria. — Dr. Jousset considers this the princi- 
pal remedy for migraine or hemicrania, especially at 
the climacteric in women whose menses are profuse. 
He uses from the twelfth to the thirtieth dilutions; 
vertigo, rush of blood to the head with buzzing in 
the ears, and flushes of heat: headache in paroxysms, 
beginning in occiput, it spreads upwards and settles 
over the right eye ; headache, with nausea and chilli- 
ness, followed by flushes of heat extending from the 
head to the stomach ; sometimes bilious vomiting, short 
shooting pains in the head, and shivering. The head- 
ache is better in the open air, from lying down, and 
from sleeping. It is an excellent remedy for flushes 
of heat at the climacteric, and fetid, corrosive leu- 
corrhoea at this time. 



CHAPTER V. 

PRURITUS VULVAE, OR ITCHING OP THE 
GENITALS. 

(Compare the chapter on ; * Vaginitis.") 

This is very distressing to some ladies, especially at 
the change of life. Fortunately, it is easily cured in the 
majority of cases. The itching is sometimes due to a 
parasite, and then as a rule it is the Ped \i 'cuius pubis , vul- 
garly known as the crab louse. It is readily recognized 
by the presence of minute points or "nits" attached to 
the hair, or by seeing the vermin. A few thorough 
washings of the parts, especially the hairy portions, 
with a five per cent solution of carbolic acid is sure to 
eradicate them. Indeed, in all forms of pruritus not 
distinctly traceable to something else for a cause, it is a 
good rule in domestic practice for a patient to bathe her- 
self for three alternate nights with the carbolic lotion, 
and see if it does not give relief. The odor of the car- 
bolic acid is objectionable to some persons, who might 
prefer to use a solution of corrosive sublimate, one part 
to a thousand parts of water. This last solution will 
certainly destroy all the vermin after washing the parts 
with it twice, but the solution is poisonous if taken 
internally, and must be kept in a safe place. It is easily 
prepared by purchasing a small bottle of Wyeth's anti- 
septic mercurial tablets of any apothecary, and making 
the solution according to the directions on the label. 



74 PRURITUS VULVAE. 

If there is a moist, scabby, or scaly eruption on the 
parts which itch severely, it is probably eczema, or ' ' salt 
rheum." The urine should then be always carefully 
tested by a physician for sugar, as this condition is often 
due to diabetes. If caused by diabetes, the use of the 
old-fashioned liver of sulphur ointment will bring great 
relief. If this cannot be had, make a lotion of one 
ounce of the hyposulphate of soda to a quart of warm 
water, and bathe the parts freely with it. 

These measures will not suffice in a few instances, as 
when it is due to an unusually sensitive condition of the 
nerves. Under these circumstances the remedies men- 
tioned below will be found very serviceable. Marchand's 
peroxide of hydrogen, full strength, has been sprayed 
on the itching surfaces by an ordinary hand spray with 
good results for itching during pregnancy. Another 
local application which gives much relief is a few drops 
of oil of peppermint and a smaller amount of oil of 
cloves in a little very warm water, to be used in bathing 
the parts or to be applied on pieces of linen. A tea- 
spoonful of powdered borax in a pint of warm water 
used night and morning is another good and convenient 
application. 

Cleanliness is very important, especially if there are 
any irritating or offensive discharges. Under these cir- 
cumstances, but not in eczema, bathing the itching 
places two or three times a day is none too often, using 
castile or honey and juniper tar soaps, and drying 
them very carefully afterward with old soft linen. 
Should the vagina be the seat of itching, obtain Calen- 
dula cerate of the druggist, containing four per cent of 
the muriate of cocaine ; or, if this cannot be had. Plan- 



PRURITUS VULVAE. To 

tago and Boracic acid cerate. The latter is an invalu- 
able application for many cases. Make an oblong wad 
of dry absorbent cotton the size of the vagina, smear it 
thoroughly with the cerate, and after the bath insert it 
in the vagina, tied round with a strong piece of string 
to remove it. If some difficulty is found in using the 
cotton, the author's ointment syringe is very useful to 
apply the ointment. (See page Si.) Exceptionally heat 
will relieve, and then the patient may find some relief 
from an ordinary hot poultice. Pinworms sometimes 
cause severe itching, and may lead to bad habits in little 
girls. An ointment of one part impure, i. e., crude 
carbolic acid and twenty parts of cold cream, thoroughly 
rubbed about the parts and around the anus, will 
speedily destroy them. 

"While the many applications mentioned are of un- 
doubted value, their effect is often temporary, and the 
final cure of the case must depend on the remedies. 
Except when otherwise mentioned, give a dose of the 
third decimal preparation once in three to six hours, as 
the severity of the case may demand. No one should 
drink coffee who suffers from itching of the privates. 

Therapeutics. 

Arribra. — Violent itching of the vulva during preg- 
nancy, with soreness, itching, and swelling of the 
parts ; discharge of blood between the periods from 
slight causes, as after a hard stool or walking ; menses 
too early and too profuse ; urine turbid, depositing a 
brownish sediment : uterine symptoms worse on lying 
down. 

I Ccdadium seguinum is considered by some the 



76 PRURITUS VULYJK. 

best remedy, others prefer Conium. Severe itching of 
the external genitals ; crampy pains in the uterus after 
midnight, itching during pregnancy, itching pimples on 
the genitals. 

Cantharis. — Itching at the change of life ; swelling 
and irritation of the vulva ; violent itching in the 
vagina. Pruritus, with strong seamed desire. Frequent 
urination with burning, cutting pain. 

Carbo veg. — Red, sore places on the genitals ; 
itching, sore, and raw, with thin leucorrhcea in the 
morning on rising, which ceases during the day, also if 
the leucorrhcea is milky and causes smarting ; menses 
too early and too profuse ; blood too thick and of a strong 
odor ; dilated veins on the parts, or if the mucous mem- 
brane looks as if bits of curd were sprinkled on it. 

Coffea. — Severe itching without eruption or leu- 
corrhcea in a person of a very nervous temperament 
and great mental activity. 

| Conium. — Severe itching deep in the vagina; 
leucorrhcea with weakness and paralyzed sensation in 
the small of the back before the discharge, also if it is 
thick, milky, with contracted, labor-like pains coming 
from both sides, discharge of white, acrid mucus, caus- 
ing burning ; violent itching in the external genitals and 
vagina, especially after the menses ; the white particles 
like curdled milk on the surface are also an indication 
for the use of this remedy, but not so often as for 
Carbo veg. 

Graphites. — Occasionally called for when the skin 
of the body has an unhealthy appearance, subject to 
itching Notches from which oozes a watery, sticky fluid} 
moist eruptions behind the ears; itching of the external 



PRURITUS VULVJE. 77 

genitals before menstruation ; menses too scanty, too 
late, and too pale. 

H Kreosote the author has found a most excellent 
remedy for violent itching and smarting of the external 
genitals and vagina during and after menstruation. 
Sometimes the external genitals are swollen, hot, hard, 
and sore. Leucorrhoea of a yellow color, staining linen 
yellow, with great weakness. 

Eh us tox. — Vesicular or pustular eruptions, with 
burning and itching, also for eczema. If this fails, try 
Croton tig. 



CHAPTER VI. 

LACERATION OF THE PERINEUM.— CYSTOCELE.- 

RECTOCELE.— ABSCESS OR BOILS IN THE 

EXTERNAL GENITALS. 

These are surgically treated, and therefore do not 
properly come within the scope of a domestic work. 
Reference to chapter first will readily show what is 
meant by a laceration of the perineum. Tl lis takes place 
in labor ; and though much can be done to prevent it. 
laceration will sometimes take place with the most skil- 
ful and experienced physicians. This laceration readily 
heals if two or three stitches are properly taken, and a 
physician who neglects to carefully examine and stitch 
such lacerations at once after delivery does a great wrong 
to his patient. Whoever you may be, my reader, rest 
assured when you hear a physician bragging that no pa- 
tient of his has had a laceration, that he has never had 
many lying-in patients, has never carefully examined 
them, or if so, does not know a laceration when he sees 
it, or is else telling you an untruth. 

The ultimate consequences of these lacerations are 
serious as a rule. The rectum bulges forward into the 
vagina near the orifice, and forms what is known as a 
rectocele. Constipation and straining at stool increase 
it, so that it finally pulls down the uterus. The anterior 
wall of the vagina, having lost its support, bulges back- 
ward and downward at the vaginal orifice, and is then 



LACERATION OF THE PERINEUM. T9 

called a cystocele. This is very much aggravated by 
retaining the urine, as is too often done by many ladies 
from false modesty or because it is not perfectly conven- 
ient to urinate. The utmost limit a healthy lady should 
ever go without passing urine is six hours, and it should 
be passed once in four hours when possible. In a large 
cystocele, all the urine cannot be forced out of the blad- 
der. It decomposes, and in time will cause catarrh of 
the bladder. 

More important even than these sequelae is the dis- 
placement of the uterus which so often follows. This 
organ sinks lower and lower till it finally reaches the 
vaginal orifice, or may even "come into the world," 
forming what physicians call complete prolapse or pro- 
cidentia of the uterus. This generally completely unfits 
the woman for an active life, and may keep her in bed 
most of the time. 

In a few exceptional cases, the ligaments and fascia 
supporting the uterus are unusually strong, uninjured, 
and the organ does not become misplaced. Is there any 
way a lady can tell for herself whether it is likely that 
she must have an operation ? The following simple rule 
will determine it in the great majority of cases : If she 
notices that air escapes from time to time from the 
vagina, especially in changing positions of the body, it 
shows that the vaginal entrance is not properly closed, 
and an operation will be necessary in all probability, par- 
ticularly if she has a feeling of weight and bearing down 
in the pelvis, and she can only walk a short distance. A 
thoroughly competent physician or rather a specialist 
should be consulted at once. Better have a simple oper- 
ation performed in the beginning than try to fight it off 



80 LACERATION OF THE PERINEUM. 

by months or years of increasing suffering, ending in a 
more serious and difficult procedure. If done early, there 
is no danger and but little, if any, pain. Three weeks' 
detention is generally quite enough, and the woman 
resumes her place in the household with a prospect of 
health before her, where sickness and suffering surely 
awaited her before. Take the earnest advice of the 
author, do not dally with yourself too long. 

Abscess or Boils in the External Genitals. 

The symptoms, management, and treatment of this 
painful affection are similar to that given for boils 
elsewhere in this book. , In the newly married, abscess 
is sometimes caused by excessive sexual indulgence. 
In rare instances an abscess at one side of the vaginal 
opening becomes chronic, and requires an operation to 
cure it. Abscess in the perineum, if at all large and 
accompanied by much swelling, should be treated by a 
physician and opened early, owing to the liability of 
its breaking into the rectum and forming a fistula. 

The formation of an abscess or boil is readily recog- 
nized by the swelling, redness, exquisite sensitiveness, 
heat, or pain which is often throbbing and worse on walk- 
ing. Apply hot, thick flaxseed poultices at frequent 
intervals, and when the boil breaks and discharges matter, 
bathe it carefully with castile soap and water, and cover 
the surface with a soft piece of old linen on which 
Calendula cerate is thickly smeared. 

Belladonna. — In the beginning of the boil, the local 
application of the strong tincture of Belladonna or 
Arnica sometimes will disperse it. A dose of the third 
dilution once in two hours is excellent at the com- 






LACERATION OF THE PERINEUM. SI 

mencement, when there is much throbbing pain, head- 
ache, or some fever. 

| Hepar sulphur. — If the above treatment gives no 
relief, give Hepar sulphur 3 * every three hours to hurry 
the formation of matter. It is also good for chronic 
cases when the discharge is corrosive, smells bad, and 
there are pimples around the principal opening. Stop 
this remedy after the discharge freely appears. 

I Mercurius virus is another valuable remedy and 
good to take when the Hepar sulphur has been stopped. 
If there is much chilliness with thirst, and the pains are 
worse at night, it should be given instead of the Hepar 
sulphur to hasten the suppuration. Dose, a poAvder of 
the third decimal preparation once in three hours. 

Silicea 6x . — Is adapted to old chronic cases with 
fistulous openings and when the discharge is copious, 
protracted, and unhealthy. A dose three times a day 
before meals. 

Sulphur 3 *. — A dose three times a week is excellent 
to prevent the recurrence of boils. 



CHAPTER VII. 

VULVITIS. - VAGINITIS. 

(Compare chapter on "Pruritus Vulvae.") 

This is an inflammation of the mucous membrane 
of the external genitals or of the vagina. In domestic 
practice three forms are met with, — simple, virulent, 
and scrofulous. 

Simple inflammation of the vulva or vagina may 
come from some local injury or application, sexual 
indulgence, uncleanliness, masturbation, or the presence 
of acrid, irritating leucorrhcea. The parts are at first 
hot and dry, but soon become bathed with a muco- 
purulent secretion. The mucous membrane is red, 
somewhat swollen, and raw in places. Sometimes there 
is severe itching, but seldom any pain on passing urine. 

Virulent or gonorrheal inflammation of these parts 
is the result of specific infection after impure sexual 
intercourse. It generally develops within forty-eight 
hours afterward, and soon becomes severe, with very 
painful and frequent passing of urine. A thick yellow 
or greenish offensive pus is discharged which irritates 
the thighs. As a rule there is much pain in urination, 
and abscess of the external genitals is not an uncommon 
consequence. 

One thing is of great importance in this disease, »'. <?., 
that none of the matter be conveyed to the eye in any 
manner, as it would surely cause a severe inflammation, 



VULVITIS. — VAGINITIS. 8 3 

and loss of eyesight often follows. It is often very 
important to know if the cause of the inflammation is 
really impure connection and gonorrhceal infection. 
This a scientific physician can readily determine at an 
early stage by a proper examination for the germ of 
the disease. Little girls, especially those of scrofulous 
tendencies, are not uncommonly subject to inflamma- 
tion of the parts, and parents are apt to think they 
have been violated, when it is rarely the case, and when 
other positive signs and injuries would be present. Pin- 
worms, uncleanliness, cutting the teeth, and masturba- 
tion are causes not to be overlooked. The symptoms 
are similar to those of the simple form, and the disease 
is readily cured. 

Eruptive diseases of the genitals are usually attended 
by much itching. The reader is therefore referred to 
the chapter on "Pruritus Vulvae." Some women suffer 
from inflammation of the vagina during pregnancy. It 
does no harm other than the discomfort it causes, and 
disappears after confinement. Very rarely, elderly 
ladies suffer from vaginitis, accompanied with much 
itching, burning, and some yellowish, watery, vaginal 
discharges. It differs from ordinary vaginitis from the 
fact that adhesions are apt to form in the canal, which 
becomes narrowed in its upper part. Physicians are 
liable to overlook it, as ladies over fifty are seldom 
troubled with inflammation of the genital organs. 

Rest and a simple nourishing diet should be observed 
when a lady is under treatment for vaginitis or vulvitis. 
Great attention to cleanliness is of the utmost impor- 
tance. Vaginal or vulvar douches of* six quarts of tepid 
water containing a little castile soap should be employed 








84 VULVITIS. — VAGINITIS. 

from one to four times a day, according to the amount 
and character of the leucorrhoea. If very profuse, 
yellow, offensive, or excoriating, four times a day is 
none too often, while for a little bland discharge once 
a day is quite sufficient. After using this cleansing 
douche, one of the following medicated douches is very 
useful after first washing the parts. Any one of the 
first four preparations can be used in ointment form 
and applied to excellent advantage after the medicated 
douche, the parts having been carefully dried mean- 
time by soft linen. If the vulva are inflamed, smear 
the inflamed surfaces freely with the ointment, and 
insert a piece of r 
clean soft linen 

DetW eeil tHeni. Kl(i - Southwtck'B Ointment Injed 

If the case be one of vaginitis, use the author's 

ointment injector (Fig. 5) ; warm the injector in quite 

warm water, fill it for one inch 
from the end with the cerate, 
insert it in the vagina far as it 
will go, and then force out the 

FlG. 6. South wick's l'a>tillr . J T -, . , 

cor self-treatment. ointment. I have recently suc- 

ceeded in having pastilles prepared for my patients 
to use at home. They are of the same size and shape 
as Fig. 6, contain the different drugs as may be re- 
quired, and are easily inserted by the finger. It is 
well to wear a small, thin napkin to prevent the 
clothing from being sailed. A large, thick napkin 
pinned tight to the person is too heating. The men- 
strual pads made of absorbent cotton, cotton waste, 
wood wool, or gauze are an excellent substitute for the 
ordinary napkin. 




VULVITIS. — VAG IXITIS. 8 5 

Calendula. — Four teaspoonfuls of the aqueous fluid 
extract to a pint of warm water is very excellent, if the 
mucous surfaces are raw and excoriated. 

Hydrastis. — Two teaspoonfuls of the aqueous fluid 
extract to a pint of warm water, if there is a profuse 
catarrhal or pus-like secretion. It is a most excellent 
application for the gonorrhceal form ; equal parts of the 
aqueous fluid extract of Hydrastis and Boroglyceride 
will promptly cure most of these cases. 

Eucalyptus. — Same proportion as the Calendula. 
when the discharge is thin, yellowish, and very offen- 
sive. 

Plantago and Boracie acid cerate, if the inflamma- 
tion is very acute with little white spots like particles 
of curdled milk on the mucous membrane, also if there 
is much itching. If this fails or is not at hand. Ha ma- 
in el is cerate, or the aqueous extract six teaspoonfuls 
to a pint of water, is an excellent and very soothing 
application. 

Kreosote. — Ten to thirty drops well stirred in a pint 
of lukewarm water is very good for severe itching, bit- 
ing, and smarting of the parts, together with a profuse 
and offensive discharge. 

Corrosive sublimate makes the best wash when the 
disease is of impure and specific origin. (See, also, 
Hydrastis and Boroglyceride.) Use only the com- 
pressed tablets made for antiseptic purposes ; one part 
to one thousand of water, according to directions on 
the label. I usually order Wyeth's tablets. 

Goulard's E.rtract. — A small teaspoonful to a pint 
of water used as an injection three times a day is also 
valuable for gonorrhceal vaginitis. Where there are one 



86 VULVITIS. — VAGINITIS. 






or two very small, red, itching, painful spots on the 
mucous membrane, which the patient can distinctly see 
with the aid of a hand mirror, equal parts of carbolic 
acid (crystals) and glycerine can be applied with great 
relief, but only in the following manner, as this prep 
aration is very strong and must be used with care 
sharpen a small piece of wood, a toothpick often answers 
the purpose, dip the point in the solution, wipe the end 
on the edge of the bottle to take off the excess, as you 
would a pen on an inkstand, now touch only the affected 
point of tissue with it and nowhere else. If properly 
applied and the lotion lias the right strength, a whitish 
spot will be seen. A single application is sometimes 
sufficient, and a second one should not be made within 
two weeks. 

Therapeutics. 

| Arsenicum 931 trit., a dose once in four hours, is best 
suited to vulvitis, with shooting pains from the abdomen 
into the vagina; burning, tensive pains in the ovary, 
especially the right ; profuse, yellow, thick, corroding 
leucorrhcea. 

Cede, cai'b.-^ trit., a powder the size of a pea half an 
hour before each meal, is best suited for chronic cases, 
or in blond women subject to frequent attacks of the 
disease ; swollen glands, boils, or chronic abcesses, 
scrofulous persons ; profuse sw r eat about the labia; 
stinging, burning pimples on the margin of the labia ; 
aching in the vagina ; violent itching and soreness of 
the vulva ; inflammation and swelling of the genitals ; 
leucorrhcea like milk, with itching and burning. 

I Oantharis**, a dose once in two, three, or four 



VULVITIS. — VAGINITIS. ST 

hours, according to the severity of the symptoms. 
Specific, i.e., gonorrhoea!, inflammation; swelling and 
irritation of the vulva ; violent itching in the vagina ; 
strong sexual desire ; inflammation of the icater passage 
with frequent and painful passing of the urine. 

Carbo veg.** trit., a dose once in four hours. It is 
more especially suited to women who have passed the 
change of life, unless the symptoms more closely resemble 
another remedy. Inflammation, with white spots on 
the mucous membrane like grains of curd, and with 
itching, soreness, and rawness, during the leucorrhcea, 
which is thin, excoriating, milky, only in the morn- 
ing when rising ; enlarged veins about the vulva. 

I Kreosote Gx , a dose every two hours. Burning be- 
tween the thighs on urinating ; soreness between the 
thighs and vulva with burning, biting pains; soreness 
and smarting between the labia ; violent itching of 
the labia, also of the vagina ; external genitals swollen, 
hot, hard, and sore ; yellow leucorrhcea with great 
weakness, staining linen yellow. 

|| Mere. sol. 3x trit., if the preparation be fresh, other- 
wise use Mere, viv., a dose once in three hours. This is 
by far the best general remedy for vaginitis and vulvitis 
from any cause, with rawness, smarting, and excoriated 
spots ; leucorrhcea worse at night ; greenish yellow 
discharge ; smarting, corroding, itching, burning after 
scratching ; itching of the genitals worse from the con- 
tact of the urine. 

Sepia 6 * trit.. a dose once in three hours. Great dry- 
ness of the vulva and vagina ; painful to the touch ; 
itching eruption on the small labia, which are red and 
swollen ; much weight and bearing down of the pelvic 



88 VULVITIS. — VAGINITIS. 

organs ; leucorrhoea yellow, milky, excoriating, and 
especially before the menses. 

Thuja?* four times a day is often .sufficient to cure 
the numerous hard, long, pointed warts about the 
vagina, which follow gonorrhceal inflammation. If it 
fails, use Nitric acid 6x in the same way. 

Large, flat excrescences, but little raised from the 
surface, with a moist top, occurring about either the 
vagina or anus, should be shown at once to a reliable 
physician. They are an indication of syphilis, and soon 
will undergo extensive ulceration if not treated promptly. 






CHAPTER VIII. 

VAGINISMUS. — ATRESIA. — FISTULA. 



These are three conditions distinct from one another, 
but grouped together for convenience, as the existence 
of any one of them requires the attendance of a skilful 
physician, excepting a few cases of vaginismus, which 
can be cured by home treatment. 

Vaginismus 

Really means a spasm of the vagina, especially at the 
external orifice, which may be very painful ; its mean- 
ing also is extended sometimes to painful conditions 
about the vaginal orifice, independent of any actual 
spasm. The latter is really very rare, so much so 
that one of the ablest gynecologists in Europe denies 
its existence. This affection is practically a symptom 
of some abnormal condition, and a careful examina- 
tion must be made and the cause discovered to cure 
the case. The following are the more common causes : 
Small, exquisitely sensitive tumors at the entrance 
of the urethra (urinary passage) ; cracks or fissures 
in the mucous membrane about the orifice ; minute 
red spots in the mucous membrane which are very 
sore to the touch ; scars in the perineum after child- 
birth or a poor surgical operation ; excessive sexual 
intercourse is a common cause ; less often, inflam- 
mation about the uterus, or a displacement of that 



90 VAGINISMUS. — ATRESIA. — FISTULiE. 

organ, chronic inflammation of the genital canal and 
lead poisoning. 

Treatment. — So far as possible, every cause must be 
removed. Sexual intercourse must be entirely discon- 
tinued. Warm sitz baths and hot vaginal douches of 
water will do much to allay irritation ; after each one 
apply freely some Calendula cerate if there are fissures 
or excoriations, or if not, use Hamamelis cerate. If 
not better in a few days, the patient may apply, very 
carefully, on a pointed stick, equal parts of carbolic acid 
(crystals) and glycerine to the painful places only, and 
repeat it if necessary in ten days or a fortnight. It is 
hardly necessary to state that ladies suffering from 
vaginismus are usually sterile for the simple reason 
that complete sexual congress cannot be endured. 
Attempts to conceive have been made unsuccessfully 
under the influence of ether and various applications. 
such as an eight per cent cerate of cocaine applied freely 
just before congress, in the hope that childbearing 
would cure the complaint. It would probably do so in 
many cases were it possible to conceive and carry the 
child to full term. Should the treatment here given 
prove insufficient, a surgical operation is usually neces- 
sary, which the author has described in his Manual of 
Gynecology. 

Therapeutics. 

Cuprum cured a case of vaginismus of nine years' 
standing following pregnancy, The spasms were quite 
severe, painful, and came on at short intervals a number 
of times a day. Take a dose of the Gx trituration once 
in four hours. 



VAGINISMUS. — ATRESIA. — FISTULA. 91 

Hamamelis** once in three hours,. Vaginismus, 
intense soreness and itching of the genitals ; bloody 
leucorrhcea with great tenderness of the vagina ; menses 
are- too profuse and protracted ; blood bright, fresh, and 
does not clot; soreness and aching in the ovaries; dis- 
tention of the veins about the genitals or on the legs. 

Plumbum 3 * trit., three times a day before meals. 
Vaginismus in women subject to severe, excruciating 
pains about the navel, with depression of the abdomen 
at the time of the pains. Constipation, with dis- 
charges lumpy like sheep's dung, and urging with 
severe pain from constriction or spasms of the anus. 
Sharp, neuralgic pains in the limbs, especially in the 
muscles of the thighs, extreme emaciation, sleepless- 
ness. 

Pulsatilla^, once in four hours. Crampy constric- 
tion of the vagina ; leucorrhcea milky, thick, with 
swollen vulva, painless, thin, acrid, or burning ; menses 
too late, scanty, and of short duration. 

Atresia 

Means complete or partial closure of. the genital canal. 
While this is generally a condition with which such a 
patient is born, atresia may follow any severe inflam- 
mation of the canal, especially after sloughing has 
taken place. 

In cases where the vaginal canal has never developed 
and consequently does not exist, there is very little hope 
of having a new canal made which will be of any value 
to the patient. Modern surgery has, however, devised 
a way of relief. The writer wishes to remark here that 
a very careful examination by an experienced physician 



02 VAGINISMUS. — ATRESIA. — FISTULA. 

is necessary to determine the correct state of things. 
The woman herself is not always able to determine 
whether the vaginal canal exists or not, on account of 
the following condition, which is not uncommon. In 
women who have had no sexual intercourse there is a 
very thin band of mucous membrane across the posterior 
part of the vaginal orifice. This commonly ruptures 
at the first sexual congress, causing a little bleeding ; 
and it was in olden times, as it still is in Oriental countries, 
considered the seal and proof of virginity, hence it was 
called the hymen. Modern observation, however, has 
shown there are exceptions to this rule. It is occasion- 
ally so firmly developed and so strong that entrance into 
the vagina is prevented, and the woman is of course 
sterile. A number of such cases have applied to me for 
relief, which I have been able to give in a short time 
without a surgical operation, by some graduated tubes 
which I designed for that purpose. 

This membrane, or hymen, may sometimes grow 
across the entrance of the vagina so as to close it 
entirely and prevent the escape of the menstrual fluid. 
This is called an imperforate hymen. The menstrual 
blood cannot then escape and will collect within the 
vagina and uterus, forming in the course of some years 
a large collection of fluid which may cause much local 
pain and disturbance of the nervous system. Such a 
condition might be easily mistaken by a person for 
absence of the vagina, which would be a serious mis- 
take. In fact, it is an imperative rule that if a girl 
reaches the age of eighteen without menstruating, she 
should be carefully examined by a thoroughly com- 
petent physician. This becomes all the more impera- 



VAGINISMUS. — ATRESIA. — FISTULA. 93 

tive if the girl has had at regular intervals the symp- 
toms of menstruation without any discharge. Hard 
though it may be for a sensitive girl to undergo an 
examination, which can be made very simple and with- 
out any exposure, a false modesty and exaggerated 
delicacy must not allow one to shrink from duty and 
allow a young woman's life to be seriously injured or 
even lost by it. It is of course necessary to restore the 
vaginal orifice to its natural condition, so that the men- 
strual fluid can readily escape. 

This is a simple matter if properly done, but instances 
are known where young women have died from blood 
poisoning, and no inexperienced physician should be 
trusted to perforin even such a small operation. 

Fistulse 

Are only of interest in domestic practice so far as an 
exj^lanation is concerned, as such cases should be in the 
care of the physician. A fistula is an opening between 
the bladder and vagina, the vagina and rectum, or be- 
tween the rectum and the skin. The latter are usually 
small canals discharging matter. They may be single 
or multiple, are complete when they extend into the 
rectum, incomplete when they do not have an opening 
into the rectum. The fistula? first mentioned are most 
often due to some injury in labor ; those which are 
between the skin and rectum are commonly the result 
of boils or abscesses. 



CHAPTER IX. 

AMENORRHEA. 
(< !ompare li ( Jhlorosis.") 

We are now about to consider the various phases of 
the menstrual function, which plays such an important 
part in the female economy, and has such an important 
influence upon the health of a woman. Any disturbance 
of it demands careful attention, and is never to be con- 
sidered lightly as a matter of no importance or treated 
as carelessly as some ladies who ought to know better 
are in the habit of doing. Many an invalid now thinks 
of the past, and sighs in vain for health and beauty, lost 
from causes clearly traceable to improper care of herself 
in regard to her menstrual periods. The menstrual 
function may be truly considered the weUspring of a 
woman's life, with which she can never afford to 
tamper. 

Like other anomalies of the uterine discharges, insuf- 
ficient or absent menstruation is not a disease in itself, 
but an expression of some abnormal condition of the 
system, when it occurs during the generative life of a 
woman, except during pregnancy and lactation. In the 
latter, it is purely physiological, and need not be con- 
sidered here. Amenorrhoea, as considered in this chap- 
ter, should not be confounded with the delayed periods 
or the skipping of periods, at the iW change of life." 
which is a natural attendant on that condition. The 
forms and causes are outlined in the following table : — 






AMENORRHEA. 



95 



Suppressed 

flow 



Amenorrhcea 1 Scanty or 
delaved flow 



Retention of 
flow 



Plethora. 

Mental emotion, sucb as fright, anxiety, 
disappointed love. etc. 

Cold and wet, such as wetting the feet 
during the menses. 

Exhausting diseases, such as tuber- 
culosis or chlorosis. 

Sea voyage, or change of climate 

Lack of ovarian stimulus, mental strain. 
and overwork. 

Local inflammation, such as ovaritis. 

Imperfect or non development of the 
sexual organs. 

Atrophy of the uterus or ovaries. 

Lack of fresh air. exercise, and good 
wholesome food. 

Occlusion of some portion of the genital 
canal. If congenital, it is usually at 
the entrance of the vagina : if not con- 
genital, the occlusion is most com- 
mon in the upper third of the vagina. 



The causes of the first two forms may produce either 
condition, though most often the relations are as classi- 
fied above. 

Suppression of the menstrual flow from mental emo- 
tion, cold, wet, or pulmonary consumption, is one of the 
most common disorders the physician is called upon to 
treat. Amenorrhcea, associated with a slight cough, 
emaciation, or rise in temperature, for any length 
of time, should always be looked upon with grave sus- 
picion, especially in scrofulous subjects, as it is not 
infrequently the forerunner of phthisis. 

The effect of a sea voyage on emigrants, in producing 
amenorrhoea. is due to the poor fare on shipboard, and 
the change of climate on their arrival, rather than the 
voyage itself. The latter, in fact, is one of the best reme- 
dies for this condition in those who have been overworked 
mentally and physically, and need absolute rest ; among 



96 AMENORRHCEA. 

them belong schoolgirls just entering on their menstrual 
life, and young women who have been compelled to 
study hard, in addition to the demands of society and 
fashion. The nerve force is diverted from the natural 
channels, and some derangement is sure to follow. 

On personal inquiry, the writer has been surprised 
to find the prevalence of amenorrhcea in young women 
from sixteen to twenty in our colleges and seminaries. 
This is not invariably the case, however. Dr. Hall, of 
Vassar College, informs me that, of sixty-six girls who 
had studied hard preparing for college, thirty -seven 
report little or no inconvenience at any time dining their 
menstrual histories ; eleven have improved since their 
first menses, and have little or no inconvenience now; 
seven are slightly more inconvenienced than at first, two 
decidedly more so ; and nine, who are some what troubled, 
report no change since the menses were first established. 
Dr. Hall thinks the few disturbances of the menses which 
occur are due to change of climate and surroundings, 
rather than study. Excluding defective development, 
she has found these cases the most difficult to t feat while 
pursuing their studies ; next to these, amenorrhcea 
depending on ovaritis has proved very stubborn. 

The lack of fresh air, exercise, and proper food very 
commonly leads to defective nutrition and chlorosis. 
Nature is obliged to close the safety-valve, and retain 
the blood for the use of the body, just as in exhausting 
diseases. This is partially compensated for by a watery 
leucorrhoea, instead of the usual flow. It need not be 
viewed with apprehension, but rather shows that the 
monthly congestion of the pelvic organs is taking place, 
and that Nature will again assert herself when the 
organism can afford to lose the menstrual blood. 



AMEXORRHCEA. 07 

The prognosis of amenoTrhoea depends largely on 
the exciting cause. If the latter can be removed, the 
prognosis as to cure is very favorable ; indeed, there are 
comparatively few incurable cases. 

The general treatment is indicated, by the above ; 
i. e.< remove the cause. For the treatment of scanty 
and painful menstruation the reader is referred to the 
chapter on ' ' Dysmenorrhea. " The hot-water foot-bath 
is very useful for suppression of the flow from cold and 
wet. If due to a low vitality of the system, or chlorosis, 
hygiene is of prime importance. Do not force the flow 
in pale, bloodless girls. Build them up, and when 
nature can afford the loss of blood, the menstrual flow 
is almost sure to appear. Well- ventilated sleeping apart- 
ments, exposure to the sun's rays, with exercise in the 
open air, either walking, riding horseback, or playing 
tennis, but never to such an extent as to make the 
patient feel exhausted afterwards, plain, nutritious food, 
mental rest in schoolgirls, physical rest at the time of 
the expected monthly, and early retiring hours are very 
essential for a cure. 

Milk and cocoa are the best drinks ; strong tea and 
coffee are sometimes positively injurious, particularly 
the former. An inquiry into the patient's habits of 
eating and drinking will often give a clew to the best 
method of treatment. These measures may be aided 
by a change of air or a sea voyage. In short, the great 
object is to develop robust health and strength, and 
nature will see to it that the menses return without the 
interference of art. Here, forcing remedies and power- 
ful emmenagogues would do positive harm. 

The patient may be in fairly good health, but suffers 



AMENORRHEA. 



from sudden suppression of the menses ; the symptoms 
are those of cerebral and, less often, pelvic congestion, 
dizziness, flushed face, nosebleeding, together with a 
feeling of fulness and weight in the pelvis, especially at 
the time when the next period should appear. In these 
cases, mild medicines are admissible just before and at 
the expected time ; enemas of quite warm salt and 
water and the hot foot-bath are excellent adjuvants. 

The question naturally arises, when does amenor- 
rhcea in young girls demand interference? As a rule 
for all cases, so long as the patient is perfectly well, 
leave her alone i<> nature, aided by good hygiene. But 
when the menses arc scanty and painful, or there is not 
a drop of menstrual blood, notwithstanding she has had 
all the symptoms of menstruation for a continuous 
number of monthly cycles (imperforate hymen), a 
thorough examination is imperatively necessary with- 
out further delay. CTnless there is a faulty or inflamed 
condition of some of the pelvic organs, local treatment 
is inadmissible and quite uncalled for, as then amenor- 
rhcea is but a symptom of the general condition of the 
patient. 

As in dysmenorrhcea, the medical and hygienic 
treatment should be of a constitutional character, every 
symptom between the menstrual epochs being carefully 
considered. If the flow fails to appear, continue the 
same plan of treatment until about a week before the 
period should come, and then substitute some remedy 
having a more decided action in promoting a menstrual 
flow. This may be aided by hot foot or sitz baths, which 
are of little or no use in the interval. It is hardly neces- 
sary to add, that while the patient is improving in 



AMENORRHCEA. 90 

general health, and there is a decrease of morbid symp- 
toms, the same remedy had better be continued. Even 
if the flow does not appear for two or three months, 
Nature will assert herself in time. 

Therapeutics. 

Take a dose of the third decimal preparation three 
times a day half an hour before each meal. If a period 
goes a week or ten days longer than usual, it is not 
likely to appear before the time for another period. It 
is often necessary to take a remedy three weeks before 
an opinion can be formed of the good it does. Stop the 
medicine when the flow appears. 

I Aconite is an invaluable remedy for sudden sup- 
pression of the menstrual flow, from a chill, fright, or 
vexation, with the usual congestive phenomenon, espe- 
cially in plethoric women. Ovaritis may accompany it. 
with painful urging to urinate and high fever, also 
anxiety and great restlessness. The best results from 
it will be obtained when it is given promptly at the 
time of the exciting cause. If a number of days have 
elapsed, and the next period does not appear, Pulsatilla 
is generally more suitable ; less often, Lycopodium. 
Kiickert records a case of six months' suppression in a 
plethoric young woman, with precordial anguish and 
asthma, which was entirely relieved by Aconite. 

Belladonna. — Amenorrhcea in plethoric women: 
sudden suppression of the flow, with much pressure and 
throbbing in the head. ha?matemesis : feeling of weight 
and fulness in the pelvic organs. When amenorrhcea 
is due to plethora, Dr. Hughes recommends Bella- 
donna in the intervals, and Aconite at the period- ; 



100 AMENORRHCEA. 

nosebleeding ; tickling in the nose ; drawing pains 
from the sacrum extending down the thighs, much 
bearing down in the pelvis, especially in the right 
side, and profuse sweat before the menstrual flow, 
feeling of coldness, wakefulness ; offensive menstrual 
discharge. 

|| Calearea carb. — A very important remedy for 
delayed menstruation in scrofulous girls, those who are 
fleshy, weak (with large abdomens), fair complexion, 
perspire very easily about the head, and are subject to 
acidity of the stomach and constipation ; perspiration 
of the feet, which feel as if she had on cold, dam]) stock- 
ings ; feeling of weakness in general ; easily fatigued 
in walking ; dizzy on ascending a height, or going up 
stairs ; very sensitive to cold air. There is reason to 
believe this remedy may avert the development of 
tuberculosis in these cases. Dr. Ludlam says : " Abun- 
dant experience lias satisfied me that the Calearea car- 
bonica is perhaps the most prominent and useful remedy 
for the relief of those menstrual irregularities which 
are incident to pectoral disease." 

|| Cimicifuga. — Dr. Cowperthwait esteems ik this 
more generally useful in all classes of amenorrhcea than 
any other remedy," better than Pulsatilla, and always 
gives it when there are no special indications present. 
Nervous women subject to rheumatism, neuralgia, 
myalgia, occipital headache, flashes of pain, and sore- 
ness of the eyeballs. Menses irregular, delayed, or 
suppressed from cold, or mental emotions, and attended 
by muscular twitchings or hysterical manifestations. 
Neuralgia of the uterus. Pains dart from side to side. 
Aggravation of mental symptoms at time of the men- 



AMEXORRHCEA. 101 

strual periods. Bearing down, dragging, and soreness 
of the pelvic organs. 

Cocculus. — Menstruation too early, abdomen dis- 
tended, with contracting, cutting pain, or painful pres- 
sure, as if from stones. Menstruation, which had been 
absent one year, immediately reappeared. Suppressed 
menstruation, with pressing abdominal pain, flatulence, 
and general weakness. Scanty, irregular, painful men- 
struation. Dysmenorrhcea with a profuse discharge of 
clotted blood and subsequent hemorrhoids. Uterine 
cramps, with suppressed, irregular menstruation and 
sero-purulent bloody discharge. 

Glonoine. — Severe throbbing in the head, and pale 
face, with amenorrhcea, particularly in plethoric women ; 
the cerebral congestion is intense from the sudden sup- 
pression. This remedy acts very promptly, if at all, 
and is very useful at the climacteric period. 

I Graphites ranks near Pulsed ilia as a remedy for 
delayed or tardy menstruation, with scanty, pale flow. 
Dr. C. AVesselhoeft, who has recorded a number of cases 
of insufficient menstruation treated by it, thinks it is 
better adapted to patients over thirty years old, and is 
to the climacteric what Pulsatilla is in youth. Dr.' 
Dudgeon has shown its application to amenorrhcea with, 
indurated ovaries, and Hahnemann recommended it for 
delayed menstruation associated with great constipation. 
The stools are offensive, dark, half digested, and lumpy, 
united by mucous threads. The skin is unhealthy, villi 
eopcoriations, fissures, or itching blotches, from which 
exudes a corrosive, sticky, watery fluid. Itching of the 
external genitals^ before menstruation. The patient 
tends to obesity, and her troubles to become chronic. 



102 AMEXORRHCEA. 

Dr. Bonninghausen mentions it for amenorrhoea, with 
itching or eczematons spots between the fingers. 

Lycopodium®*. — For amenorrhoea in young girls. 
after Sulphur, when the skin is sallow, bowels con- 
stipated, urine dark, with brickdust-like sediment, 
sour taste, afternoon aggravation ; loud rumbling of 
flatus in the bowels ; bloated after eating ; amenorrhoea, 
with rheumatic pains. 

|| Pulsatilla. — While tins is the chief remedy for 
amenorrhoea from exposure to cold and wet, or for a 
flow which is scan///, too late, and of short duration, it 
is often abused by prescribing it in every case, as 
routine practice. It is very useful for delayed iirst 
meases in girls of a mild, tearful disposition, who are in 
fairly good health; menstrual suppression complicated 
with ophthalmia or supraorbital neuralgia; delay in 
the lirst appearance of the menses, suppression of the 
flow from wetting the feet ; drawing, pressing pain 
toward the uterus, more especially in the left side; 
wandering pains shifting rapidly from one part of the 
body to another; pale, flabby girls who complain of 
much weariness and prostration ; longing for fresh air, 
better in the open air and in a cool place; does not feel 
as well in the evening or in a warm room ; fat food 
always disagrees. Constant chilliness, even in a warm 
room, and much coldness of the whole body at the time 
of the period, are good indications for this remedy ; less 
often there is an intolerable dry burning heat at night 
without thirst ; amenorrhoea with a disordered stomach. 

Sepia. — Menses are scanty, flow dark; excessive 
prostration, exhaustion and faintness, flushes of heat. 
much weight anel bearing down in the pelvis. Dr. 



AMENORRHEA. 103 

Jahr recommends it. next to Pulsatilla, tor the delay of 
the first menses, if there is a leucorrhceal discharge 
instead, with determination of blood to the chest, and a 
pale face. It is an excellent remedy for the yellow 
discoloration* of the skin and face in women subject 
to menstrual derangements, especially when they are 
over the bridge of the nose. 

Sulphur. — Dr. Jahr ranks Sulphur with Pulsatilla 
for insufficient menstruation with pale flow. There is 
pressure in the pit of the stomach during the menses, 
and the patient is subject to flushes of heat, cramps in 
the calves of the legs and soles of the feet, with burning 
in the latter at night, rush of blood to the head, and 
heavy, pressive frontal headache, especially in the 
morning, or on the vertex, like a heavy weight on top 
of the head ; itching, burning eruptions on the skin ; 
restless sleep at night, sleeping in the day. 



CHAPTER X. 

MENORRHAGIA AND METRORRHAGIA. 

The former term means profuse menstruation ; the 
latter applies to a discharge of blood from the genitals 
between the menstrual periods. Neither can be con- 
sidered a disease in itself, but is secondary to or symp- 
tomatic of other diseases, such as : — 

Fibroid tumors of the uterus. 

Polypoid degeneration of the endometrium (endome- 
tritis prolifera or hyperplastic endometritis). 

Retention of the placenta, i. e., afterbirth, after 
abortion. Subinvolution. Ovaritis. 

Engorgement of the portal circulation. 

Cardiac disease and valvular insufficiency. 

Telluric influences, such as malaria. 

In short, a persistent flow of blood from the uterus is 
often clue to some tumor or growth witJiitt that organ, if 
its h istory does not date from pregnane}/. There are some 
women who naturally flow very profusely, and yet are 
not well unless they do. Such persons are liable to 
have the monthly period come on in three or four 
months after confinement, and flow so severely as to 
make them anaemic, hysterical, and seriously interfere 
with their ultimate recovery, unless the discharge is 
controlled in some manner. 

The quantity is so variable that the question 
whether the patient is flowing too much should be 
decided by its effect on the organism. If a woman fl< >ws 



MENORRHAGIA AND METRORRHAGIA. 105 

profusely, and is pale, weak, anaemic, has white ears, 
complains of dizziness, and the mucous membrane of 
the mouth and tongue is pale instead of pink, there is 
reason to believe it is due to loss of blood. In all cases 
of profuse and persistent flowing, an examination should 
be made without delay to ascertain the cause, and, if 
possible, to remove it. Some cases depending on the 
presence of foreign growths, such as fibroids, will par- 
tially, and occasionally wholly, yield to treatment, so 
that the patient will pass safely through the climacteric 
without having to submit to a surgical operation. In 
other cases profuse flowing is one of the first signs of 
cancerous disease of the uterus. 

The diet should be generous ; milk, eggs, beef in 
some form, or a good extract of it ; mutton chops ; 
strong broths and soups in small quantities, but often. 
Lemonade, oranges, and grapes are refreshing to the 
patient, and the acid in them seems to have a beneficial 
influence. Stimulants are to be proscribed, as they often 
do more harm than good, except in rare instances 
temporarily to revive a patient with tendency to syncope. 
Where there is marked anaemia I have sometimes seen 
good effects from the use of beef, wine, and iron ; but 
in the very great majority of cases patients will do 
much better withot it. 

Local Treatment. — In many cases very little if any 
is necessary other than the removal of any tumors, if 
present, or scraping the cavity of the uterus if the flow- 
ing has followed a miscarriage. The proper remedy, 
carefully selected, will prove the best styptic. Douches 
of hot water will sometimes diminish the flow tempo- 
rarily ; and the benefit to be derived from the hot- water 



106 MENORRHAGIA AND METRORRHAGIA. 

spinal bag applied to the spine near the hollow of the 
back must not be forgotten. The douches can be 
repeated as often as three times a day if necessary, and 
if the patient does not feel exhausted afterward. 

Sometimes a change of air alone will cure the patient. 
I have seen a lady well advanced in the climacteric 
flow very profusely and continuously at the seashore, 
without receiving any benefit from local or internal 
treatment, even from curetting the uterus and the 
application of iodine. But on removing four or five 
miles inland, the hemorrhage ceased in a short time, 
and she became perfectly well. 

If the bowels are constipated, and hinder free p< 
circulation, they should be emptied by enemas. Rais- 
ing the foot of the bed a couple of inches, and keeping 
the head and shoulders low, tend to lessen the amount 
of blood in the pelvis. Plenty of fresh cool air, cool 
food and drinks, in the most severe cases, are advisable. 

Therapeutics. 

Generally speaking, the remedies applicable to menor- 
rhagia and metrorrhagia are also valuable in the thera- 
peutics < >f abortion. The efficacy of medicine is beautifully 
illustrated in its effect on uterine hemorrhage, if it be of 
non-puerperal origin ; but in the majority of cases one 
remedy alone will not be sufficient to cure the patient. 
Xew symptoms may arise, others be cured, and a second 
or even a third remedy must be substituted for the one 
previously given. The remedies are to be given in the 
third decimal preparation, unless otherwise stated ; a 
dose once in two, three, .or four hours, according to the 
severity of the case. As the flow diminishes, always 



MENORRHAGIA AXD METRORRHAGIA. 107 

give the medicine less frequently, and stop it when the 
discharge ceases. If a woman is in the habit of flowing 
too profusely or too often, she should always take the 
remedy best indicated between the menstrual periods ; 
a dose three times a day, half an hour before meals. 
The value of medicine is too often underestimated. I 
have been able repeatedly, by the use of remedies, to 
save women from painful operations. 

|| Belladonna. — The u t erine and menstrual sy mp - 
toms resemble Sabina, but the general condition of the 
patient is characteristic of Belladonna. Great pressure 
downward in the genitals, as if the contents of the 
abdomen would protrude through the vulva • menses too 
early and too prof use ; bright red, or thick, decomposed, 
dark red blood which feels hot to the parts ; burning, 
throbbing in the right ovary ; tremulous feeling through 
the whole body ; gentle pressure on the uterus, or 
motion of the hands and feet, causes vertigo and 
nausea, without retching or heaving ; rush of blood to 
the head ; pains come and go suddenly ; very sensitive 
to smell and noise ; painfully distended abdomen ; 
worse after three p. m. and after midnight. Dr. Carroll 
Dunham recommended it for offensive metrorrhagia, 
and for extremely offensive menstruation in young 
unmarried women. 

Bryonia. — Menses irregular ; too early and too pro- 
fuse, with dark red blood ; splitting headache, worse 
from motion; flow increased by least motion; uterus 
engorged and tender to touch ; great sensitiveness 
throughout pelvis, worse in right ovarian region ; sharp, 
stitching pain in right side, aggravated by coughing or 
moving, or even deep inspiration ; can hardly bear the 



108 MENORRHAGIA AND METRORRHAGIA. 

least touch of affected parts. A patient was taken 
with flowing within a week from the date of cessation 
of the normal period, and flowed profusely. The symp- 
toms corresponded to those of Bryonia as given above. 
Improvement at once commenced, and she was speedily 
cured. 

I Calcarea carb. is an invaluable remedy. It is 
indicated by the general conditions and symptoms of 
the patient, rather than those' peculiar to the sexual 
organs. Menses too early, last too long, and are too 
'profuse] leucorrhoea like milk, with itching and burn- 
ing in the genitals ; scrofulous diathesis, and tendency 
to pectoral disorders ; feet feel cold and damp ; much 
sweat on the labia, the head, and on the feet. Dr. 
Guernsey recommends Calcarea, and also Silicea, for 
monorrhagia in nursing women ; profuse perspiration 
on the least exertion; very sensitive to cold air; swell- 
ing of glands, especially under the jaw and in the 
groins ; cannot bear tight clothing about the waist ; not 
very strong, easily fatigued in going upstairs. Calcan << 
phosphor tea is rather better than Calcarea carbon tea 
when the menorrhagia is in young girls who suffer 
from an increase of leucorrhoea in the ratio that the 
menses diminish, and with pimples on the face with 
yellow matter in them ; rheumatic pains from every 
cold, and frequent attacks of headache. 

I Chamomilla. — Irritable, impatient, peevish mood; 
very sensitive to pain, which cannot be endured ; the 
floiv is dark and clotted; the clots large, and associated 
with severe labor-like pains in the uterus; drawing, 
griping pains from the sacrum or K small of back forward 
to the pubic bones ; the pains are followed by the 



MENORRHAGIA AXD METRORRHAGIA. 109 

discharge of clots : the menses are too early, profuse, 
and sometimes offensive ; the flowing is in paroxysms. 

China. — This remedy is of great value in relieving 
the debility from loss of blood. It can be given with 
advantage between the periods, in case of anaemia. — 
here I prefer the second or third trituration of the bark, 
— while some other remedy is used instead at the time 
of the flow. Cases of malarial origin, where the symp- 
toms show a marked periodicity, and also for women 
suffering from sexual excesses. Profuse perspiration 
at night ; patient complains of being chilli/, with thirst 
before or after the chill ; menses too early, profuse, 
black clots, with spasm in chest and abdomen ; profuse 
flowing for weeks after a miscarriage. (Such cases 
usually require scraping of the womb.) 

I Crocus. — Bearing down before menstruation; 
metrorrhagia of dark, viscid, stringy blood, in dark 
clots, worse from least motion ; functional menorrhagia, 
particularly in young women ; sensation as if some- 
thing living were jumping about in the pit of the 
stomach and abdomen. I prefer the 2x dilution. 

Erigeron. — Premature and profuse menses; metror- 
rhagia, with violent irritation of rectum and bladder ; 
very profuse flow of bright red blood; every movement 
of patient increases the flow. Give the oil of Erigeron 
in two-drop doses on a little sugar once in two or three 
hours. 

Hamamdis**. — If the flow be passive, small amount 
but continuous, color usually dark, may be bright ; if 
there be a hemorrhagic diathesis, and tendency to venous 
engorgement, menorrhagia associated with subacute ova- 
ritis, the blood slowly trickles away and is not coagu- 



110 MENORRHAGIA AND METRORRHAGIA. 

lated. Dr. D. Dyce Brown recommends Hamamelis 
for uterine hemorrhage, especially if abortion is threat- 
ened, or if it follows abortion. The flow is more often 
dark and venous, but he does not limit its action to 
any color of the discharge. 

| Ipecac. — Menses too early, profuse, and of bright 
red blood, which coagulates readily. It is accompanied 
by nausea, great weakness, and cutting, griping pains 
in the abdomen. 

Magnesium carb. — Menses delayed. The discharge 
is usually viscid and glutinous, but may be coagulated. 
A peculiar symptom, often verified, is that the flow is 
more prof use at night than in the daytime. 

Nux vomica. — If the patient is cross and quarrel- 
some, sensitive to noise, talking, strong odors, and bright 
light, thickly coated tongue, pressure and load in the 
stomach after eating, constipation ; women who have 
lived on highly seasoned or rich food and taken much 
medicine. The menses are too early and too profuse; 
during the tne uses, nausea in the morning, with chilli- 
ness, attacks of faintness, and pressure to/card the 
genitals. The symptoms are worse in the morning 
after eating, from motion, from mental exertion, and 
in the open air. 

I Platina. — Menses too early and too profuse, last too 
long, discharge dark and thick ; may be clotted and 
accompanied with bearing-down pains in the abdomen. 
There is increased sexual desire, particularly after the 
flow ceases ; also painful sensitiveness and constant 
pressure in the genital organs; body feels cold, except 
the face ; hypersensitiveness and irritability of the 
genital organs ; the patient has the most exalted self- 



MENORRHAGIA AXD METRORRHAGIA. Ill 

esteem ; premature development of sexual instinct ; 
and for older women when the metrorrhagia is asso- 
ciated with melancholia. 

WSabina. — Dr. Hughes recommends its use both 
during and between the periods ; metritis, accompanied 
by flooding ; menses too early, too profuse, last too long ; 
hemorrhage from the uterus in paroxysms, worse from 
motion, blood dark and clotted, or may be light colored 
and florid ; after abortion or labor ; pain from back to 
pubis ; increased sexual desire. Hering states that the 
metrorrhagia is increased by the least motion, but often 
better from walking. 

\\ Secede cor. has been recommended for uterine 
hemorrhage, when the uterus is atonic and hyperaemic, 
in doses of the tincture sufficient to secure uterine con- 
traction. It is also useful in dilutions, but in either 
case the preparation must be fresh. Hemorrhage from 
the uterus, worse from the least motion; discharge 
black, fluid, and very fetid ; also, if it is attended with 
labor-like pains, extreme debility, prostration, and rest- 
lessness. Dr. Kafka states that he has used Ergotin in 
many cases of profuse menstruation, especially for 
women who have given birth to many children near 
together, when the flow was perfectly painless and 
increased by the least active or passive motion, and 
never has known it to fail. 

Trillium. — Hemorrhagic diathesis ; flow returns 
every fortnight with yellowish, creamy leucorrhoea 
during the intervals ; the flow is of bright color, some- 
times with clots, and comes in gushes on .the least 
emotion. It is especially suitable to the climacteric, 
and has been used with success for uterine hemorrhage 



112 ' MENORRHAGIA AND METRORRHAGIA. 

depending upon the presence of fibroid tumors. Men- 
struation too early and too profuse, irregular, flowing 
for two weeks ; pain in hips, short breath, palpitation, 
restlessness in legs ; hips and legs feel as if they would 
fall apart. 

Vicarious Menstruation. 

In very rare instances a woman may have little or 
no menstrual flow in the ordinary manner, but suffer 
apparently instead from bleeding from some other part 
of the body once a month. The most common places 
are the nose, stomach, anus, lungs, breasts, and ulcers. 
I have seen one woman who lost blood every month 
from the nipple of her right breast. Occasionally a 
woman does not menstruate, but has, instead, a profuse 
watery diarrhoea every month. The condition men- 
tioned above is called vicarious menstruation, and is 
often associated with poor health and faulty nutrition 
of the body. It is always important to have a thorough 
examination made in these cases, to be sure there is no 
obstruction to the natural discharge of menstrual fluid. 

The general treatment of vicarious menstruation is 
just the same as for amenorrhcea, to which the reader 
is referred. The importance of constitutional remedies 
and treatment must never be overlooked. 

Therapeutics. 

1 1 Bryonia. — Besides other symptoms which may be 
present, it is applicable for vicarious menstruation in 
the form, of nosebleeding ; also, for suppression of the 
menses with nosebleeding in women accustomed to too 
early and too profuse menstruation. The blood is florid, 



MENORRHAGIA AND METRORRHAGIA. 113 

and the bleeding is most often in the morning, some- 
times waking the patient from sleep. While Bryonia 
is especially applicable to the above, it should not be 
forgotten in other forms of this affection, as clinical 
experience shows it is one of the chief remedies. 

Ferrum. — Dr. Leadam's favorite remedy; anaemic 
women subject to fiery red flushing of the face ; sup- 
pression of the menses with spitting of blood from the 
lungs. 

\ Hamamelis. — Vicarious menstruation of dark or 
venous blood from the nose, mouth, stomach, or hemor- 
rhoids. The presence of varicose veins, and a fluid 
rather than clotted condition of the blood, are additional 
indications. 

I Pulsatilla. — Bleeding from the nose or stomach, 
or expectoration of pieces of dark coagulated blood, 
with suppression of the menses. The pressive throb- 
bing headache, palpitation, chilliness, and the above 
symptoms, with scanty or delayed menstruation, are 
additional indications for this remedy. Dr. Kapper 
reports an interesting case cured in six weeks by this 
remedy. The principal symptoms were violent head- 
ache, dazzling before the eyes, twitches in the nose, 
tightness of the chest, fulness of the mammae, and 
oppression of the stomach, followed by violent epistaxis 
and flow of blood from the breasts, with relief and 
cessation of all the symptoms. These symptoms had 
been repeated for a number of successive months. The 
girl was apparently well, eighteen years old, and had 
never normally menstruated ; warm sitz baths, leeches, 
and purgatives had been tried without any benefit. 



CHAPTER XL 

DYSMENORRHEA, OR PAINFUL MENSTRUATION. 

This is not a disease in itself, but a symptom, i. e.< 
it is secondary to some primary affection. Strictly 
speaking, a healthy woman should never suffer severe 
pain with her menstrua] period, and. as a rule with 
very few exceptions, there is no need of a woman suf- 
fering the agony that many do. It may require time, 
but remedies will cure the majority of eases without 
local treatment. The exceptional eases will he those 

where there is a mechanical cause for the pain which 
will require manual treatment. It is impracticable to 
specify here the many causes of painful menstruation, 

hut the following are the more common ones: sudden 
suppression of the menstrua] flow, such as wetting the 
fleet, sitting on cold stones or damp ground at or near 

the time of the menses; neuralgia, rheumatism, spasm 
of muscular tissue in the neck of the uterus; displace- 
ment of that organ and inflammation of the ovary, 
especially when caused by the application of nitrate of 
silver to the uterus k% to burn out the ulcers." as it has 
been called, — a brutal practice which has left many a 
woman much the worse for such treatment. 

There are two forms of painful menstruation which 
deserve special mention. The first is when the pain 
comes a week before the flow. This is sometimes asso- 
ciated with disease of the Fallopian tubes, and if the 



DYSMENORRHEA, OR PAINFUL MENSTRUATION. 115 

patient has ever contracted gonorrhoea, i. e., a disease 
from impure coition, an operation will generally be 
necessary to cure her. This pain for a week before 
the menstrual flow ought to be treated by a skilful 
physician. 

The second form of painful menstruation is that 
known as membranous dysmenorrhoea, and is charac- 
terized by the discharge of a whitish membrane or thin 
flesh-like masses, in one or several pieces at each 
monthly period. I have had patients come to me in 
great alarm at such an occurrence, and pure, innocent 
girls have been suspected of having an abortion in con- 
sequence of the appearence of this membrane. It is to 
be remembered, therefore, that the discharge of such a 
membrane is quite independent of both pregnancy and 
sexual intercourse, and that its presence does not in 
any way cast reflection on the individual. 

This form of painful menstruation is particularly 
difficult to cure, and sometimes can only be cured by 
an operation, which always will be efficient if properly 
performed. 

The theory has been advanced that if a young 
woman is overtaxed, especially mentally, at the time 
she becomes a woman and during the complete estab- 
lishment of the menstrual periods, say from fourteen 
to eighteen, the nutrition of the genital organs is 
perverted so that sterility, complete or partial, dys- 
menorrhoea. and imperfect development of the uterus 
foUow. We are not yet in a position to absolutely 
affirm or deny this theory, which seems to have at least 
a certain amount of truth in it. Careful statistics show 
that of all married women who had dysmenorrhoea in 



116 DYSMENORRHEA, OR PAINFUL MENSTRUATION. 

early life, 71.90 per cent were sterile. This very strik- 
ing relation of sterility to dysmenorrhea in early life, 
makes the latter of more importance than is commonly 
supposed. It should be made a rule then, a duty of 
every mother for the good of her daughter in after life 
that if pain continues to a marked degree throughout 
the period, and is repeated from month to month, in 
spite of carefully selected remedies, an examination 
must be made. It is a false delicacy which allows 
diseases and consequent suffering to become established, 
which might have been cured at their commencement. 

Childbearing usually brings much relief from painful 
menstruation, and on this account marriage is advisable 
in some cases. I would, however, entirely discounte- 
nance the idea that "when she is married she will be 
all right." Memory calls to my mind many eases as 
I write this, urging me to warn my readers of such a 
false, though common, opinion. I wish to state most 
emphatically that a girl suffering from diseases pecul- 
iar to her sex is seldom benefited by marriage, and 
is often totally unfit for married life and its many 
responsibilities. 

The use of opiates to relieve the pain is bad practice : 
it merely relieves, does not cure, and very easily leads 
to the opium habit. Rest in bed or at least in the h< >use 
for thirty-six hours before the flow and during it, is 
not, as a rule, appreciated by women who suffer from 
painful menstruation. It is of the greatest importance, 
together with a nourishing, generous diet and outdoor 
exercise between the periods. Not infrequently a change 
of air, such as a sea voyage, is beneficial. 

When the flow is scanty and painful, a foot-bath 



DYSMENORRHEA, OR PAINFUL MENSTRUATION. 117 

taken in the following manner, as soon as pain is felt or 
the flow seen, is beneficial : The patient must prepare for 
bed, and, sitting on the edge of the latter, soak her feet 
in hot water and mustard, with blankets well wrapped 
around her, till the skin begins to perspire. The action 
of the skin may be hastened by drinking hot, weak tea, 
or hot water with a little essence of ginger, while the 
temperature of the foot-bath is increased gradually by 
the addition of a little more hot water. (See page 49, 
• ■ Hygiene of Puberty and the Climacteric. ") A bottle of 
gin is very often kept in the house as a remedy for 
scanty or suppressed menses. "When perspiration com- 
mences, the patient lifts her feet out of the water, keep- 
ing them in the blankets without stopping to wipe them, 
and lies back in bed. This, with proper medicines, is 
usually sufficient to bring on the suppressed menstrual 
flow or to increase a scanty discharge, unless some few 
days have elapsed since the suppression, when it is of 
little use to try it before the time of the next period. 
In the interval between, copious hot-water vaginal 
douches, with an occasional addition of four tablespoon- 
fuls of glycerine to a pint of water for an extra douche 
immediately afterwards, are useful to allay the tendency 
to passive congestion. 

Pounded ice, in flannel bags four inches wide and 
twelve long, is often beneficial for healthy, vigorous 
women who suffer from painful menstruation with a 
scanty and tardy discharge and much nervous restless- 
ness. They are to be used from ten minutes to half 
an hour at a time, once or twice a day. when the pain 
comes, and to be applied from the middle of the small 
of the back upward over the spinal column. Rubber 



118 DYSMENORRHEA, OR PAINFUL MENSTRUATION. 

bags, known as Chapman's spinal bags, can be bought 
for this purpose, and are better than flannel, as they can 
be worn underneath the clothing without wetting it. 

An electric current from an ordinary Faradic battery 
is also helpful in many cases. Never use a stronger 
current than is easily borne. Place one sponge over the 
lower end of the spine and the other sponge electrode 
over the region of the bladder, and after five minutes 
change this sponge to each side near the groin for five 
minutes in each place. The battery should be used 
every day, unless it causes aching or distress in the 
pelvis afterward, when it must not be employed as 
often. Sometimes a better effect is obtained by insert- 
ing a vaginal electrode into the vagina as far as it 
will go, and using the electricity in the same way. 
It is needless to remark that electricity is not to he 
employed during the flow. (See page HO.) 

A very important point to hear in mind in medically 
treating dysmenorrhea is that the medicines must be 
faithfully taken between the periods, it cure is desired. 
Medicine taken only at the time of the pain may relieve 
for the time being, but the cure must come from con- 
stitutional medicines previously taken. 

The application of a hot-water bag, hot flannels, or 
a compress of warm hamamelis to the site of pain is 
often grateful to the patient. It is better to abstain 
from tea and coffee for some days before, during, and 
after the menstrual flow. 

Therapeutics. 

Unless otherwise mentioned, the following medicines 
are to be taken in the third decimal preparation. A 



119 

dose night and morning for three weeks before the 
flow, then for a week before the flow a dose before each 
meal and on going to bed ; at the time of the pain 
take a dose every half -hour or less often, i. e., two 
hours, according to the severity of the pain, and less 
often as it diminishes. Do not take any medicine dur- 
ing the flow, if there is no pain. 

Aconite. — Dysmenorrhea in consequence of sup- 
pression of the menses, especially from fright or vexa- 
tion in full-blooded ivomen accustomed to profuse floiv- 
ing. The pain is sharp and cutting ; the vagina hot, 
dry, and sensitive, with painful urging to urinate. The 
patient is very restless, tosses about, thirsty, feverish, 
and the jmlse is full, hard, and strong. 

Ammonium carb. — Dysmenorrhea in persons of a 
nervous, sanguine temperament, suffering from crampy 
pain in the uterus, mostly before the flow. The latter is 
dark or clotted, abundant, and occurs oftener than once 
in four weeks. In connection with it there is usually 
diarrhoea two or three clays before the flow and some- 
times with it ; also painful menstruation, with the 
menses premature and abundant, and preceded by grip- 
ing, colic, and want of appetite ; often pain between the 
shoulder-blades. 

Belladonna. — Very severe pain, dragging and 
pressing down in the pelvis, worse in the right side ; 
paroxysmal pains preceding the flow from six to 
twenty-four hours. Severe, congestive, throbbing head- 
ache before the menses is almost always cured by this 
remedy. It is also useful for sudden suppression of the 
menses from cold, with severe bearing-down pain and 
throbbing in the uterine region ; flushed face, throbbing 



120 DYSMENORRHEA, OR PAINFUL MENSTRUATION. 

headache, and difficult or painful micturition ; pains 
coming and going quickly. 

Calcctrea carb. is an important remedy to be taken 
between the periods, if the patient be scrofulous, subject 
to glandular swellings, sour stomach, perspiration about 
the scalp, menses every three weeks and too profuse, 
especially at puberty, and if the pain is brought on 1 > y 
exposure to cold or Avet. 

Caulophyllin. — Spasmodic pains in the uterus and 
various parts of the uterine region. The now is either 
scanty or normal in women subject to rheumatism of 
the small joints. It is also useful for moth-spots on the 
face, in women subject to menstrual irregularities or 
leucorrhoea. 

Chamomilla. — Neuralgic dysmenorrhoea, the flow 
is too early, too profuse and offensive ; drawing pain 
forward from the lower cud of the spine ; griping, [Hitch- 
ing, labor-like pains in the uterus, followed by the dis- 
charge of large clots of blood ; the patient is impatient. 
irritable, and very sensitive to pain and to smell. 

\ Cimicifuga 2 *. — Dysmenorrhoea in women suffer- 
ing from muscular rheumatism. Insufficient menstru- 
ation, menses irregular, delayed, or suppressed ; hyster- 
ical or epileptic spasms at the time of the menses ; ovarian 
pains shoot upward, uterine pains from side to side ; 
bearing down and tenderness in the region of the 
bladder ; limbs feel heavy ; dull aching and soreness in 
the back of the head ; nervous shuddering, restless 
sleep, soreness of the large muscles, chiefly along the 
spine ; sore spots in the muscles ; soreness of the ovaries 
during menstruation. The following case does not 
present many characteristics of this remedy, but it 



DYSMENORRHEA, OR PAINFUL MENSTRUATION. 121 

shows what excellent results can be obtained from 
medicine : — 

Mrs. , set. 24, nervous temperament, brown hair and eyes, 

medium height and weight, overworked at school; constipated, menses 
usually regular, normal quantity, sometimes light, sometimes dark, 
extreme soreness in the ovaries, severe cramps and pains throughout 
the abdomen, sometimes pains through lower limbs to the knees: 
slight leucorrhceal discharge like the white of an egg before the period ; 
no pain or odor with it ; is frequently cold and at times has cold per- 
spiration; weak back, sometimes pain below the kidneys; spinal 
column very sensitive to the touch; hands perspire copiously; feels 
very languid after exertion, and is generally worse before noon; has 
Buffered very severely with her periods for four years. I made one 
application of electricity to the uterus and gave Cimicifuga Sx , a dose 
once in two or three hours during the period, according tp the amount 
of pain. Xo medicine the week after the period; a dose every other 
night the second week, and then a dose every night up to the next 
period. Xo medicine to be taken with the second period, unless quite 
painful. She was very much relieved the first month, had no pain 
whatever the second month, and has remained quite well. 

Coccuhis. — An excellent remedy for dysmenorrhcea 
and menstrual colic from flatulence in the intestines, 
more often at night and especially during menstruation 
and pregnancy. Menses too early, with cramps in the 
abdomen and colic pains ; great weakness during the 
menses, severe headache on the third or fourth day of 
the flow ; light and noise intolerable, and accompanied 
by nausea, like the heaving up and down of the stomach 
in seasickness ; sudden cessation of the flow, followed 
by severe spasmodic pains ; dysmenorrhcea in girls and 
childless women ; flow may be scanty or very profuse, 
with pain in the breasts, restlessness, groaning, vomit- 
ing ; small pulse and great weakness ; leucorrhcea 
between the periods. It is a good remedy to take 
between the monthlies. 

I Gelsemium lx . — Ten drops in half a cup of hot wa- 
ter, a teaspoonful every ten minutes, and less often as 
soon as there is any improvement, which will be sure to 



122 DYSMENORRHEA, CR PAINFUL MENSTRUATION. 

follow, if at all, after three or four doses are taken, pro- 
vided the remedy was administered as soon as the pain 
commenced. It is one of the very hest remedies for 
spasmodic dysmenorrhcea. It acts quickly, and if no 
relief is experienced after the sixth dose, there is no use 
of continuing this medicine. The indications for it are : 
severe, sharp, labor-like pains in the uterine region 
extending to the back and hips ; dysmenorrhcea or 
scanty menstruation preceded by sick headache, vomit- 
ing ; congestion to the head ; confused vision ; deep red 
face ; bearing down in the abdomen ; passing large 
quantities of clear, limpid urine, which relieves the 
headache. Some constitutional remedy between the 
menses is usually necessary to complete the cure. 

\ Pulsatilla is a remedy often overlooked in prescrib- 
ing for dysmenorrhcea, and yet is one of the most valu- 
able medicines for it. Like some other remedies, its 
value is best seen when given before the periods, rather 
than at the time of the pain, when some other medicine 
is often more applicable. It is particularly useful for 
suppression of the menses from wetting the feet, and is 
always to be remembered with Aconite, for congestive 
dysmenorrhcea from this cause ; also for delayed, 
scanty, and painful menstruation. The pain is con- 
strictive, labor-like, and more often in the left side of 
the uterus, and obliges the patient to bend double. In 
Aconite, the discharge is bright red, and the patient 
inclined to plethora. In Pulsatilla, the discharge is 
dark and clotted, and the patient of the lymphatic tem- 
perament, easily crying at trifles ; constant chilliness, 
even in a warm room ; sleepy afternoon and evening, 
but cannot sleep well at night ; flatulence moving 






DYSMENORRHEA, OR PAINFUL MENSTRUATION. 123 

about in the abdomen : dyspeptic symptoms, without 

being thirsty : menstrual colic, with great restlessness, 

tossing in every possible direction. The following case 

illustrates the action of this remedy : — 

Miss . Menstruation became painful after working in a 

rubber factory, where she had to stand all the time: severe pain all 
through the flow and only during the flowing; pain always in the 
middle of the body, from the small of the back down into the pelvis, 
doubling her up so that she cannot bear to stand straight, worse on 
any exercise, better from perfect rest and warmth; some pain similar 
to this, but not so severe, for three days before the flow ; entire loss of 
appetite, food disgusted her, odor of food very disagreeable; very weak 
after the flow ; periods regular every twenty-eight days, flow thick, 
stringy, dark, often very offensive. She had suffered for seven years. 
I gave her Pulsatilla 3 * for one month, which relieved her very much. 
The next month I prescribed Pulsatilla™ . After this she became per- 
fectly well, the periods painless and natural. 

I Seca1e'- V . Pains in the uterus of an expulsive char- 
acter ; constipation after menstruation ; brunettes who 
are inclined to be thin and scrawny ; nausea and vomit- 
ing ; loss of appetite ; pain worse from any motion or 
the application of heat ; coldness of the abdomen during 
menstruation : cold hands and feet, especially tips of 
fingers and toes ; extreme debility and prostration after 
menstruation ; severe, agonizing pain the first part of 
menstruation ; flow thin and dark, too profuse and of 
too long duration. 

Silicea has proved a most valuable remedy taken 
between the periods when the menstruation has been 
very profuse with great pain for two or three days, 
much prostration and severe watery, painless diarrhoea 
before and during the menstrual period. 

Veratrum viride lx . — Six drops in half a cup of hot 
water, and a teaspoonful every fifteen minutes till 
better. It is a remedy not often used, as the cases 
requiring it are not common. Intense pain, more espe- 



124 DYSMENORRHEA, OR PAINFUL MENSTRUATION. 

cially before the menses, with great congestion of the 
head in plethoric women ; pain all over the body ; head 
and face look bloodshot ; pulsation in head, neck, and 
blood-vessels distinctly marked ; confusion of sight or 
disappearance of it at times is not uncommon. 

| Viburnum opulus tincture, taken the same as Gel- 
semium, will often relieve the pain like magic, but other 
remedies between the monthly periods are often re- 
quired to effect a cure. Neuralgia or spasmodic dysmen- 
orrhcea. Before the menses there is bearing down, 
aching in the lower part of the spine and in the uterus ; 
excruciating, crampy, colicky pains in the uterus ; 
much nervousness, and occasional shooting pains in the 
ovaries. The pain and nervous restlessness continue 
with nausea during the flow. 







PLATE III. 

Retroversion of the uterus in the third degree. Dotted outlines I and II show 
locations of the uterus in the first and second degrees. Compare Plate I., page 25. 



CHAPTEE XII. 
DISPLACEMENT OP THE SEXUAL ORGANS. 

There are few diseases of the female genitals more 
common than uterine displacements ; fortunately, these 
are readily relieved in most cases. 

A reference to the chapter on ' ' The Anatomy of the 
Female Pelvic Organs" will do much to make this 
subject clear to the reader. The uterus is naturally a 
very movable organ, and readily passes from a physi- 
ological position to a pathological one. Thus this organ 
may be turned forward into the position known as 
anteversion ; or backward, retroversion ; or again it 
may sag downward, forming prolapsus, or " falling 
of the womb." (Plate V.. opposite page 130.) 

All these displacements may occur without the 
uterus bending on itself. It not infrequently happens 
that the cervix of the uterus remains at or very nearly 
in its normal position and the body of the uterus is bent 
forward, i. e., anteflexion: or backward, retroflexion. 

Posterior Displacements 

Of the body of the uterus are the most common, and 
cause the patient more suffering than the other forms. 
The symptoms of retroversion (Plate III.) do not differ 
materially from those of retroflexion (Plate IV.), except 
that in the former, frequent passing of small quantities 



126 DISPLACEMENT OF THE SEXUAL ORGANS. 

of urine is more common from the pressure of the 
neck of the uterus against the bladder. As the two 
displacements are so nearly alike, especially in their 
symtoms, and are not to be treated differently in 
domestic practice, the author believes it best to group 
the two together. 

The most common and constant symptoms of back- 
ward displacement of the uterus are, a feeling of sag- 
ging or weight in the lower part of the abdomen, some- 
times so much so that the woman feels as if something 
would come out of the private pa its. 

Some ladies express their feeling as that of a sinking 
or faint sensation in the lower part of the bowels ; others 
complain of nervousness, fretfulness, and being very 
tired after walking. The next most con in ion symptom 
is persistent backache at the lower portion of the spine, 
which is very much aggravated by walking, lifting, 
reaching, straining the abdominal muscles, or going up 
and down long flights of stairs. Many ladies are utterly 
unable to Avalk half a mile or even much les^ distance. 
The pain is probably due to the pressure of the uterus 
on the sacral nerves connected with the spinal cord ; 
for this reason and also on account of the intimate 
connections of the organs of generation witli the sym- 
pathetic and nervous system in general, there are 
many other remote symptoms. 

Patients not uncommonly have pain along the spinal 
column or in spots on it. Headache, especially in the 
nape of the neck, is not infrequent. The stomach 
often suffers from the injurious effects on the nervous 
system, and a sense of weight, goneness, or sinking in 
the stomach is often observed. 




PLATE IV. 

Retroflexion of the uterus. Dotted outline shows the natural position of the 
uterus. 



DISPLACEMENT OF THE SEXUAL ORGANS. 127 

Sometimes the pain may extend into one or both 
legs, and is increased at the menstrual flow, which is 
likely to be painful. 

The third most common symptom is the frequent 
passing of small quantities of urine. 

To recapitulate, bearing down in the pelvis, back- 
ache low down, worse on exercise, and too frequent 
urination are characteristic symptoms of the disorder 
under consideration. The latter symptom is not uni- 
formly present, but I have known an excellent physician 
to keep a patient in bed for six weeks, believing she had 
catarrh of the bladder ; not being better, she came to 
me. The cause was apparent. I placed the uterus in 
its proper position, and within an hour she was practi- 
cally a well woman. 

As a result of a displacement of the uterus, besides 
the wear on the nervous system, the womb usually 
becomes very much congested, occasionally painful, and 
leucorrhcea often follows in time. The marital relations 
are sometimes distressing, and often aggravate the con- 
gestion. Sterility or barrenness is not infrequent. If 
conception occurs, miscarriage before the completion of 
the third month of pregnancy commonly results, if the 
case be not properly treated by a physician. 

The uterus often becomes displaced from an accident 
and violent jar to the body, causing severe pain in the 
pelvis, inability to walk, and other symptoms enumer- 
ated above, only of a much more severe and violent 
character. It is of the greatest importance that such 
an acute displacement be treated immediately by restor- 
ing the uterus to its normal position and keeping it 
there ; otherwise, as I have seen, the suffering woman 



128 DISPLACEMENT OF THE SEXUAL ORGANS. 

may become a hopeless invalid. Not a few of these 
displacements are due to falls while skating, falls from 
chairs, fences, jumping from wagons, etc. The more 
severe symptoms subside after a few days, and the family 
think there is no need of consulting a doctor." Such 
cases are never to be treated lightly as of little conse- 
quence. An examination can easily be made either by 
the vagina or rectum without pain, instruments, or 
exposure of the person, and may save years of suffering 
in after life. 

The enumeration of all the causes of uterine dis- 
placements would require too much space and is unne- 
cessary. The following are the more common, and may 
serve as a list of things which every woman should 
avoid doing so far as possible: — 

A sudden. jar to the body, as jumping from a fence 
or carriage, or any accident causing a sudden jar toward 
the pelvis ; moving heavy furniture, such as pianos ; 
lifting heavy weights : much reaching and long walks 
with a distended bladder, especially at or near the 
menstrual period are also common causes ; injury to 
the perineum after childbirth, and neglect of the physi- 
cian to sew up the tear, which always should be looked 
carefully for after labor ; and lastly, but by no means 
the less in importance, getting up too soon after con- 
finement. 

As less frequent causes may be mentioned, tight 
lacing and heavy skirts hung on the waist instead of 
from the shoulders ; tumors pressing the uterus down 
from above ; enlargement of the uterus, and sitting in 
easy-chairs near the centre of the seat, allowing the 
small of the back to touch the back of the chair, and 



DISPLACEMENT OF THE SEXUAL ORGANS 1$9 

bending the body forward ; constant wearing of high- 
heeled shoes also tends to produce uterine displace- 
ments. 

The author has endeavored to give the reader a 
clear account of the symptoms of these displacements, 
so that a woman can recognize the probable cause of 
her complaints, and insist on proper examination and 
treatment. In cases of long duration not a little skill 
is necessary on the part of the physician. It is a com- 
mon experience to see cases which have been examined 
repeatedly by physicians who did not find the displace- 
ment. I could mention many patients who had become 
either bedridden or chronic invalids, the attending phy- 
sician not knowing the true cause, and these same 
patients have been restored to health by proper treat- 
ment. 

One lady, in particular, had been in bed nearly all the 
time for seventeen years, supposed to be suffering from 
spinal disease. Fifteen physicians had preceded me 
with unsuccessful treatment. Possessed of more than 
ample means, she had received careful nursing and 
attention. Spinal symptoms do not always mean spinal 
disease, and, as in this case, excellent physicians are 
sometimes misled by them. A careful analysis of the 
symptoms and of the history of the case convinced me 
that a serious mistake had been made, and I found a 
.posterior displacement of the uterus, which I corrected. 
Having removed the cause of her complaints, treatment 
was directed to restoring to health, so far as possible, the 
shattered condition of her nervous system. She is now 
nearly a well woman, but her constitution has been 
seriously impaired by years of suffering and neglect of 



130 DISPLACEMENT OF THE SEXUAL ORGANS. 

the cause of her complaints, which ought to have been 
discovered years ago. 

Ladies can do much to give themselves relief, though 
a few cases of displacement are observed where patients 
make no serious complaint of their condition. These, it 
must be remembered, are comparatively few, and a 
physician known to be familiar with such diseases 
should be consulted. He will then be likely to introduce 
a pessary (Plate* VIII., opposite page 144), or to insert 
medicated tampons of wool or cotton, and to order 
copious hot-water vaginal douches to reduce the con- 
gestion. If the perineum be seriously injured, an 
operation will become necessary, which will keep the 
patient in bed for a fortnight, but she ought not to 
suffer pain at any time, except a little for the first 
two days after the operation. I now use specially 
prepared sutures, so that there are no stitches to be 
taken out. 

The only self- treatment a woman can give is adapted 
to the other forms of displacement, and will therefore 
be described after the following less important displace- 
ments have been mentioned. 

Prolapsus Uteri (Falling of the Womb) 

Has all the symptoms of posterior displacement, which 
always precedes it. The difference is, that the uterus is 
much lower down, is easily touched with the finger, or 
may even protrude into the world. If the mouth of the 
womb comes half-way to the vaginal entrance, it is 
called a prolapsus of the first degree ; if it comes to the 
vaginal orifice, a prolapsus of the second degree ; if the 
entire uterus comes out into the world, it is called a pro- 




PLATE V. 



Illustration of the three degrees of prolapsus of the uterus in dotted outline* 1 
II, and III, as compared with the natural relations of the parts. 




PLATE VI. 
Anteflexion of the uterus as compared with the normal position in dotted outline. 



DISPLACEMENT OF THE SEXUAL ORGANS. 131 

lapsus of the third degree or complete procidentia uteri. 
Walking is likely to be difficult, and in bad cases, inflam- 
mation of the bladder is not uncommon. When the 
entire uterus has remained for some months outside the 
genitals, the mucous membrane becomes whiter and 
thickened like skin; there are often ulcerated places on 
it as the result of friction, and scars where these places 
have healed. 

Forward Displacements of the Uterus (Anteversion and 

Anteflexion) 

Are not uncommon, but give the patient very little 
trouble in comparison with the posterior displacements 
just described. The chief symptom is very frequent 
passing of urine from the pressure of the uterus on the 
bladder. (Plate VI.) Sterility is more common with 
these displacements than with those just considered. 
Painful menstruation is a frequent attendant. 

Displacements of the ovaries also occur, either with 
or without displacements of the uterus, and may or may 
not be accompanied by adhesions ; but as a woman can 
do no more for herself in domestic practice than use the 
treatment about to be described, there is no use in men- 
tioning them in a work of this character. The same is 
true of those rare cases in which the uterus is turned 
wrong side out, i. e., inversion of the uterus. 

The Treatment of Uterine Displacements. 

Prevention is better than cure, is a proverb nowhere 
better illustrated than by the class of diseases now under 
consideration. Not a few women suffer the rest of their 
life as a result of getting up too soon after confinement. 



132 DISPLACEMENT OF THE SEXUAL ORGANS. 

No woman, however strong, should stand on her feet, 
much less do any work about the house, within ten days 
after delivery. Fourteen days is far too short a limit. 
Three weeks is soon enough to get around carefully, and 
if it causes any bloody discharge from the vagina, the 
woman always ought to return to bed for a few days 
more. It is important to remember that protracted 
flowing in small quantities after confinement' is an 
important symptom, denoting either a misplaced uterus 
or that something is retained in the uterus. The red 
flowing should cease entirely on the sixth day. When 
it continues after that time, always call especial atten- 
tion to it when the doctor makes his visit. 

The reader will do well to read over the list of causes 
producing displacements, and avoid them so far as possi- 
ble. Rest in bed during the entire menstrual period is 
very important in treating these displacements. 

Hot-water (112°) vaginal douches, six quarts at a time, 
night and morning, are often very helpful in diminishing 
the congestion of the uterus. (See chapter on "Puberty 
and the Climacteric Periods" and the one on "Inflam- 
mation of the Pelvic Organs.") If the sense of bearing 
down and soreness in the pelvis troubles the patient 
much, she will do well to inject into the vagina, with 
a piston syringe, one tablespoonful of the best quality 
of glycerine and an equal amount of hamamelis. This 
should be done after the hot-water douche, with the 
hips' resting on pillows considerably higher than the 
shoulders, and a napkin applied to receive the discharge 
from the vagina. The patient should remain in this 
position fifteen minutes after taking the injection, so 
that the solution will thoroughly bathe the parts. 



DISPLACEMENT OF THE SEXUAL ORGANS. 133 

If there is much burning, heat, or throbbing in the 
pelvis, especially if worse on the right side, one tea- 
spoonful of the tincture of belladonna can be used with 
the glycerine instead of the hamamelis, and applied in 
the same way. When the vagina is simply in a relaxed, 
flabby condition, and the pelvic organs are not particu- 
larly sensitive, astringent injections in the vagina will 
sometimes give temporary relief. A decoction of white- 
oak bark, strong enough to be very puckery to the taste, 
or, what is simpler, adding enough of the fluid extract 
of white-oak bark to a pint of warm water to give the 
same astringent taste, makes an excellent injection. A 
tablespoonful of glycerine added to the pint of astringent 
fluid used for the injection diminishes the dry feeling 
which commonly follows its use. Tannin and alum are 
also employed in the same way, by mixing them with 
water till the latter has a marked astringent effect. 

A great deal of relief is often obtained from an ab- 
dominal belt or supporter, which can be made easily, 
and should be fitted by another person to the 
individual who is to wear it. This is to be applied 
after taking the knee-chest position described below. 
It acts as a kind of temporary shelf to keep off 
the weight of the intestines, and pressure when 
coughing, straining at stool, lifting, etc., from the 
contents of the pelvis below. When carefully fitted, 
I have seen great relief from them, not only in 
uterine displacements, but also in various acute and 
chronic inflammations in the pelvis. Not all women 
can wear an abdominal supporter. Those with broad 
hips, bulging considerably between the trochanters 
major and crests of the hip bones, are best adapted to 



134 DISPLACEMENT OF THE SEXUAL ORGANS. 

them, as the supporter is not likely to stay well in place 
on a straight-hipped woman. 

I have had the most satisfaction from an inexpensive 
supporter, which can be made by any ingenious woman 
in the following way : The patient must first remove her 
corsets, loosen all the clothing above the hips, and lie 
down with the pelvis a little higher than her shoulders, 
and the limbs straight. A firm linen towel is then to be 
pinned tightly over the hips next to the skin, the same 
as the binder after confinement, taking care that it is 
perfectly smooth, and the lower edge an inch and a half 
below the genitals. This holds up the abdomen and 
affords a perfectly smooth surface, over which a pattern 
of firm cotton cloth or the supporter itself can be fitted. 
The latter should be made of a piece of light-weight 
but firm Russian crash about thirty- two by thirty-eight 
inches, i. e., wide enough to fold double and go around 
the patient. If the crash cannot be obtained, a firm 
piece of drilling is a good substitute. Firmness is very 
important, and for this reason, flannel, india-rubber 
sheeting, ordinary cotton cloth, etc., are totally unfit 
for the purpose. It is folded double, not merely to 
make it firmer, but especially to have all seams sewn 
inside and not press next to the skin. This is fitted 
smooth and tight over the first binder by folding over 
the upper border in places, and cutting out the slack 
cloth in the hollow of the back in a concave line. A 
Y-shaped piece an inch and a half wide and two inches 
and a half deep is cut out from the lower margin over 
each trochanter, and a couple of pieces of strong elastic 
webbing stitched in. This keeps it snug and also 
allows more motion to the limbs. Underneath each 



DISPLACEMENT OF THE SEXUAL ORGANS. 135 

gore is a lappet of cloth to prevent chafing the skin. 
Two buttons are sewed on at either side, to which the 
stocking supporters are attached, keeping the supporter 
from slipping up on the hips. Ten or a dozen small 
black or brass buckles and as many pieces of firm web- 
bing an inch wide and three inches long are sewed on 
its ends, which lap over in front and a little to the right 
side. This allows more perfect adjustment to the form. 
In some women the hip bones project anteriorly and the 
abdominal walls are so thin they would not receive suf- 
ficient support from a simple binder. In these cases a 
pad is needed corresponding to the shape of the hypo- 
gastrium. and thick enough to exercise gentle pressure, 
as if the hand were there holding up the bowels. If the 
pad be thick, curled hair is the best material ; if thin, a 
folded linen napkin answers the purpose. This pad or 
cushion should be separate from the supporter, and fast- 
ened to it by safety pins. This allows the former to be 
washed, and, by having two or three extra ones, the 
patient can wear a clean supporter as often as she likes. 
Instead of the firm webbing and buckles fastening the 
supporter in front, some of my patients, who prefer to 
have it open over the back, put in eyelets and lace it 
with elastic lacing so that the support will not bind, but 
yield more to the movements of the body. 

Sometimes three or four may have to be made before 
a close-fitting supporter is obtained, which stays in 
place and gives comfort to the wearer. 

Should this happen to prove impracticable, the 
patient will do well to purchase a Macintosh supporter, 
which often proves very helpful, especially for pro- 
lapsus of the uterus. 



136 



DISPLACEMENT OF THE SEXUAL ORGANS. 



There is one simple way by which a woman can 
often replace her nterus if it is not fixed by adhesions (see 
Plate VII.) or wedged in the pelvis. In order to do 
this, she assumes the position shown in Fig. 7, having 
on only her nightdress ; kneeling on the mattress with 
the chest touching the bed, she must separate the 
private parts by reaching behind with one hand so that 
the air will enter the vagina, and by atmospheric press- 
ure force the uterus into position. In this position, the 
intestines sag forward, and at the same time deep inspi- 
ration and violent expiration of the patient will tend to 




Fig. 7. Knee-chest position for self replacement of the utcru- by atmospheric 
pressure. The uterus displaced toward the back drops down into place as shown 
by the lightly dotted line. 

increase a vacuum in the abdomen and further help the 
uterus to assume its proper position. Coughing while in 
the knee-chest position has a similar effect. This manner 
of breathing deeply and expiring vigorously and suddenly 
is of very great importance. There is one error a 
woman is very apt to make for reasons of comfort, and 
that is to have the knees under or partially supporting 
the abdomen. This is likely to prevent benefit from the 
position. 

Particular pains must be taken to have the knees a 




PLATE VII 



Retroflexion of the uteru? and nrolin^ ^f a. 
»tllne showing the uterus iu E^£X££ ■""» """ ■*»—■■ dotted 



DISPLACEMENT OF THE SEXUAL ORGANS. 137 

little back of a perpendicular line with the hips ; to 
have the body pitch slightly forward, and one more 
important thing, to have the small of the back perfectly 
relaxed and bent down as much as possible. If all 
these directions are carefully followed, a sufferer from 
a uterine displacement can give herself much relief with 
a little practice by taking this knee-chest position, as it 
is commonly named. It should be taken night and 
morning, about ten minutes at a time, and followed by 
fifteen minutes' rest, if no other exercises are taken. It 
can of course be employed at any time as a relief to 
backache or to other discomforts. 

It is evident that any increase in strength of the 
ligaments or muscles is a great advantage when the 
uterus is out of place, its ligaments weak and relaxed, 
and the muscular structures of the pelvis too weak to 
do their duty of affording support to the womb. Simple 
as the problem seems, it has been very difficult to solve. 
A Swedish gymnast has, however, devised a method 
which has proved to be of almost inestimable value. It 
requires at least three months of daily practice. The 
development of muscular tissue, as in the blacksmith's 
arm, requires time and constant exercise. It must be 
clear that immediate results from this treatment cannot 
be expected. On the other hand, persistent effort and 
faithful observance of the directions, even if not entirely 
successful, will do much toward restoration to health. 

These exercises should be taken morning and even- 
ing with the patient dressed only in her nightgown, 
and Jying on a hard mattress or couch. Study carefully 
the position of the patient and her husband in Fig. 8. 
Notice that the shoulders are raised somewhat higher 



138 



DISPLACEMENT OF THE SEXUAL ORGANS. 



than the hips, and that her heels are placed together, 
also that when the exercises are performed she holds 
up her back and hips free from the sofa, so there is 
about six inches of space between them. 

In the first movement the patient occupies the above 
position with her knees together. Her husband or 
some strong woman sits at her side, or bends over her, 
places the inside of his hands squarely on the inner 
sides of the knees and steadily forces them apart with- 
out any jerking or sudden movements. The patient 




Fig. 8. 
Exercise to strengthen the abdominal and pelvic muscle*. 

must oppose this by firmly contracting the muscles to 
keep the knees together. She should not use all her 
strength, but enough to feel a sense of weariness after- 
ward. During this time she must be particular to 
maintain the position shown in Fig. 8, with the body 
well raised from the mattress. 

When the knees are forced at least eighteen inches 
apart, the exercises are reversed. The husband places 
his hands outside the knees and steadily forces them 



DISPLACEMENT OF THE SEXUAL ORGANS. 



139 



together, while his wife will now oppose this by 
endeavoring to keep her knees separated, her body re- 
maining in the same position as before. 

As a rule each of these exercises should be repeated 
three times night and morning at the commencement, 
and increased to ten times as soon as the patient can 
take them without too much fatigue. 

The following method of beating the spine is often 
very soothing to one 
suffering from backache, 
and is believed to in- 
fluence the circulation 
of blood in the pelvis by 
its vibratory effect on 
the spinal nerves. It 
follows well right after 
the exercises to strength- 
en the pelvic muscles 
which have been de- 
scribed above. It is per- 
formed as follows, and 
will be better understood 
by reference to Fig. 9, 
which is an illustration 
of the exercise in a 
Swedish gymnasium. Notice particularly in this cut 
how the hands and fingers are held, and how the side 
of the little finger first raps the patient, and each 
finger comes down on the finger underneath, so that- 
each little blow the patient receives is accompanied 
by the rattle of the knuckles on each other, com- 
municating a peculiar vibration to the patient. A little 




Fig. 9. 

Percussion of the spine. 



140 



DISPLACEMENT OF THE SEXUAL ORGANS. 



practice, holding the fingers loosely and nearly straight. 
will soon enable the husband or some woman to apply 
the treatment perfectly. The blows are to be on each 
side of and near the spine, never on the bones, must 
never cause pain, and are to be given in quick succes- 
sion, first one hand and then the other, i. e., alternately 
up and down the spine. Once over the length of the 
spine is enough for the first treatment, which can be 
increased to three or four times, if the patient feels 
benefited. A good position for her while receiving 
the treatment is to stand slightly bending forward and 
supporting herself with her hands on the back of a 

chair, as in the former 
exercise she should wear 
only her nightgown. 

The Faradic (electric) 
current is often very bene- 
ficial in treating uterine 
displacements. This cur- 
rent always makes a buzz- 
ing sound. A large elec- 
trode should be placed over the region of the bladder and 
connected with the positive pole of the Faradic battery. 
I have found that a good-sized napkin of Turkish towel- 
ling, folded three by four inches and thoroughly wet 
in salt and water, makes an excellent large electrode; 
the regular wet sponge electrode can be placed directly 
on top of this wet folded napkin on the abdomen, and 
the electricity be dispersed with much less smarting 
than usual. An ordinary vaginal electrode to give the 
electricity internally in a proper maimer is advisable. 
This electrode is inserted in the vagina as far as it will 




1- I(,. 10. 

Dry cell battery for domestic use. 



DISPLACEMENT OF THE SEXUAL ORGANS. lil 

enter after the large electrode is in place over the 
bladder and connected with the negative pole. The 
current from the battery is then started and gradually 
increased to only comfortable endurance. The current 
is continued at this strength for ten minutes and then 
gradually diminished. There must be no sudden shocks 
by quickly increasing or diminishing the strength of the 
current, and there is no benefit in trying to see how much 
electricity can be taken. Severe currents may do harm, 
and never do more good than moderately strong ones. 
The electricity should be taken once every day, except- 
ing at or near the menstrual period, when it might 
increase the menstrual flow. This same use of elec- 
tricity is good for scanty or suppressed menses, also for 
painful menstruation. 

The buzzing sound should be low pitched in char- 
acter, i. e.j have a slow vibration, and can be regulated 
by turning a little the thumbscrew which touches the 
vibrator near the coil. 

I have recommended with satisfaction for family 
purposes the batteries made by Waite & Bartlett, 206 
East 23d Street, New York. They cost from about ten 
dollars to sixteen dollars, are durable and perfectly safe. 
The Florence battery is one of the best cheap batteries. 
Cheaper batteries can be purchased, but, as a rule, 
they are apt to prove playthings and soon become 
useless. 

Should a lady afflicted with a displacement of her 
uterus become pregnant, she should deem it a fortunate 
circumstance. Care must be taken that the uterus is 
kept in position tiU after the fourth month, when it 
will take care of itself. As she will need a physician at 



142 DISPLACEMENT OF THE SEXUAL ORGANS. 

the time of labor, he should be summoned as soon as 
pregnancy is discovered, and acquainted with the fact 
of the displacement as a complication needing his atten- 
tion. Care after confinement, lying on the side instead 
of on the back, the attention of the physician to main- 
taining the uterus in position, and no straining or mus- 
cular efforts on the part of his patient, will do much to 
cure many cases of uterine displacement as a result of 
pregnancy. 

The question of an operation must rest largely on 
the results of treatment and the opinion of a competent 
physician. In a general way, it may be stated that a 
majority of ladies who notice air entering and escaping 
from the vagina in various positions of the body will 
need an operation. The anatomical reasons for this are 
too intricate for explanation. 

So much has been written, my reader may seem 
puzzled as to what course she should follow, and for this 
reason I add a brief resume. In the first place, persistent 
and constant effort is necessary to cure, and even then, 
many women will require the further aid of the physician 
to replace the uterus and adopt measures to retain it in 
position. Otherwise that organ is not likely to remain 
replaced but a short time. All causes or aggravating 
conditions of her complaints must be avoided. Use the 
hot vaginal douche night and morning unless it 
increases the pain, follow it with the knee-chest posi- 
tion, then the exercises of the knees ; this in the morn- 
ing with electricity, and in the evening with the beat- 
ing along the spine. This means an hour's work night 
and morning for probably three or more months, but in 
very many cases the results obtained will be well worth 



DISPLACEMENT OF THE SEXUAL ORGANS. 143 

the trial. All this time take such medicines mentioned 
below as may seem best indicated, and remain in bed 
during each menstrual period. 

When the uterus is completely prolapsed and too 
large to enter the vagina and be kept there by a band- 
age over the parts or a supporter, the patient should 
go to bed with the hips raised a little higher than the 
shoulders. The prolapsed uterus should be bathed night 
and morning with five quarts of hot water at 110° F., 
and afterward wrapped in absorbent cotton saturated 
with pure glycerine. In two or three days the uterus will 
shrink so that it can be replaced. If there are any sore 
or ulcerated places on it, the free application of Calen- 
dula cerate will help to heal them. Further treatment 
of such a case should be conducted by a physician. 

In many cases pessaries are used ; hard rubber ones 
are the best as a rule, because the soft rubber soon 
becomes very offensive. These instruments require to 
be fitted very carefully, and are then almost invaluable. ' 
Once in proper position, a woman should never be con- 
scious of its presence. As a rule, a pessary does not 
interfere with the marital relations. It never causes 
cancer, tumors, or any other awful disease which is told 
a woman either in ignorance or to scare her. Pessaries 
which do not fit may cause inflammation, and when left 
in too long may cause ulceration or become imbedded 
in the tissues in the course of a few years. No woman 
should ever wear a pessary continuously for more than 
six months without removing and cleansing it, and hav- 
ing it replaced by a physician. A pessary cannot be 
properly placed by the patient herself. Patients so 
often ask what is the position of the instrument in the 



114 DISPLACEMENT OF THE SEXUAL ORGANS. 

vagina that Plate VIII. is given to show the situation 
of a pessary for a posterior displacement. 

The question of ultimate cure is best described by 
the following classification, and will be most likely to 
take place in the order given : — 

1. Displacements from traumatism, as a fall or 
lifting, when reduced immediately. 

2 . Displacements immediately following parturition, 
if they are recognized and properly treated soon after 
delivery. 

3. Eecent displacements in women usually strong, 
but for the time being in poor health ; the pelvic organs 
in an atonic condition, but the perineum intact. A gen- 
erous diet and pregnancy arc most likely to result in 
cure. 

Marked cases of uterine displacements, excepting 
inversion, which have lasted for a number of years, are 
seldom permanently cured, though the patients may 
suffer no inconvenience if mechanical treatment be 
employed. 

Therapeutics. . 

The medicines are to be used in the third prepara- 
tion, unless otherwise mentioned ; a dose half an hour 
before each meal and on going to bed. 

Arctium lappa 1 * merits a careful trial. The writer 
has recently used it empirically in the first and second 
dilutions for many cases of retroversions, flexion, and 
descent of the uterus, with as good results as with any 
other one remedy. While there have been failures, he 
has met with considerable success in relieving symp- 
toms, and but little success in changing the position of 




PLATE VIIJ. 

Uterus held in position by a retroversion pessary. 



DISPLACEMENT OF THE SEXUAL ORGANS. 145 

the uterus, though such cases are reported. The best re- 
sults have been obtained in young unmarried women suf- 
fering from retroversion and complaining of anorexia, 
prostration of the muscular system, pain in the sacrum 
and thighs, especially the right side, and soreness in 
the pelvis. Abnormal discharges from the vagina do 
not appear to be necessary in prescribing this remedy. 

| Belladonna. — A valuable remedy, highly recom- 
mended by Drs. C. Dunham, Matheson, and others. It 
is especially applicable to cases of recent displacement, 
with active congestion of the uterus and surrounding 
structures, especially the right ovary ; back aches as if 
broken in small of back : the urine is dark, scanty, 
with frequent tenesmus of the bladder, and slight 
strangury ; the menses are too early and too profuse, 
or offensive, thick, decomposed dark red blood; the 
pelvic pains are burning, throbbing, or lancinating ; 
there is greed pressing downward in the genitals, as if 
everything would fall out : worse when sitting bent over 
or when walking, better by sitting erect or standing. 
Sepia, Xux vomica, and Pulsatilla have very similar 
symptoms, differing by the following concomitant 
symptoms : Sepia. — aggravated by sitting up, more so 
by standing, and most of all by walking ; relieved by 
lying down. Nux vomica. — constipation, but little 
leueorrhcea. Pulsed ilia. — worse from heat, better in 
open air : pressure on the bladder, with frequent copious 
micturition without strangury : copious, thick leucor- 
rhoea. On examination, the vagina is hot and dry, 
the right ovary tumefied and sensitive, and sometimes 
pulsations are felt in the congested organs. 

Calcarea carb. — Scrofulous diathesis: menses too 



146 DISPLACEMENT OF THE SEXUAL ORGANS. 

early, too long, and too profuse ; milky leucorrhoea, acid 
reaction, with itching and burning ; easy perspiration, 
profuse in the morning ; much sweat about the labia ; 
aching in the vagina, and stinging in the mouth of the 
womb. 

Conium. — Indurations of the tderns j of ovaries '; 
of breasts ; lancinating pains in the pelvic organs; sore- 
ness and swelling of the breasts before the menses ; sting- 
ing pain in cervix uteri. 

Helonias 1 *. — Sensation of soreness and weight in 

< 

the pelvis ; prolapsus uteri and ulceration of the womb ; 
leucorrhoea dark, offensive, and constant, may be 
serous, with profuse flowing : flowing on lifting, or the 
least exertion. Patient anaemic, and face sallow; 
menses too frequent and profuse : flow passive, dark, 
coagulated, and offensive. The vagina is in an irrita- 
ble condition ; the labia hot, red. swollen, itching, and 
sometimes aphthoi i s . 

Nux vomica is an important remedy for the treat- 
ment of various uterine displacements. Passive cong 
tion of the pelvic veins; pressure towards the genitals, 
especially in the morning; menses too early and too 
profuse; flow dark; during menses, morning nausea 
with chilliness and attacks of faintness ; constipation ; 
general muscular debility. Dr. Leadam recommends 
that it should be followed by Sulphur when used for 
congestion of the uterus. 

Platina. — Increased sexual instinct; with pro- 
lapsus, there is menorrhagia ; flow too car///, too 
profuse, and too long, with much bearing down : pains 
in the small of the back, extending to the groins ; great 
sensitiveness of the genital organs ; painful sensitive- 



DISPLACEMENT OF THE SEXUAL ORGANS. 147 

ness, and constant pressure in the region of the bladder 
and genital organs. 

\Secale is especially applicable to displacements fol- 
low ing childbirth. Its characteristic action on the 
uterus, such as prolonged bearing down, forcing pain in 
the pelvis, urging toward the genitals, and persistent 
atonic uterine hemorrhage of dark or very fetid blood, 
indicate it. A fresh preparation should be used persist- 
ently. 

|| Sejjia. — The simultaneous irritability of the blad- 
der and the presence of leucorrhcea, together with the 
hot flushes and the sympathetic affections of remote 
organs, serve especially to indicate it. The pain in the 
uterus, with severe bearing down and strong pressure 
in the pelvic organs, is very characteristic. The vagina 
is hot, dry, and painful to the touch. There may be 
excoriating, yellow, or milky leucorrhcea before the 
menses. The sensation of sinking or " goneness " in 
the epigastrium is a leading symptom. The bearing 
down is relieved by lying down, returns on sitting up, 
is worse on standing, and is particularly aggravated by 
walking. There is marked venous congestion of the 
pelvic organs. 

Stanniun has often proved very serviceable ; leucor- 
rhcea of yellow, white, or transparent mucus, with 
great debility ; prolapse of the vagina or uterus, with 
bearing down in the hypogastric region ; the menses are 
too early, profuse, and preceded by melancholia. 

I Sulphur is an invaluable remedy for all forms of 
uterine displacement, and must be persistently used in 
cases of inflammation and venous congestion of the 
pelvic organs. The menses are too late, too profuse, 



148 DISPLACEMENT OF THE SEXUAL ORGANS. 

and of too short duration ; the blood thick, dark, and 
excoriating ; and during the menses there is pressure in 
the pit of the stomach, burning in the vagina, and after 
the flow profuse yellowish excoriating leucorrhcea. 
The general symptoms are important, such as heat on 
top of the head, with cold feet ; burning of the soles of 
the feet, and cramps in the calves of the legs and soles 
of the feet at night. 



COLORED PLATE H 




A congested and enlarged cervix which is often associated with chronic inflam- 
mation of the uterus. The black ring represents the vagina. (Heitzman.) 




Fid. 2 

o 
Laceration, erosion, and inflammation of the cervix, which is often railed 
ulceration. The black ring represents the vagina. (Heitzman.) 



CHAPTER XIII. 
LEUCORRHCEA OR WHITES. 

By this is meant a fluid discharge from the vagina 
other than the menses. It is commonly of creamy con- 
sistency and yellowish white color. It may be much 
thinner or thicker, bland or excoriating, inodorous or 
very offensive. It is commonly worse just before or 
just after the menses, and may vary from scarcely 
noticeable moisture to a profuse discharge. 

It is not a disease in itself, and is only a symptom of 
other conditions ; the most common of these is endome- 
tritis, or inflammation of the lining of the uterine 
canal. It generally accompanies inflamed lacerations of 
the cervix, commonly called ulceration of the womb. 
(See colored Plate L, opposite page 28, and Plate II. , 
opposite page 29.) The author desires to emphasize 
that this latter condition is exceedingly rare, and the 
cases commonly called ■" ulcerations " are really only 
places where the skin is off, and in nearly all such cases 
the uterus is torn, which gives it the appearance of 
being ulcerated. The accompanying pictures of the 
appearance of the uterus as seen through the speculum 
are reproductions of very careful paintings from nature 
by a famous medical artist in Vienna. The first plate 
shows congestion of the cervix which is accompanied 
usually by slight leucorrhcea, and is often the pre- 
liminary stage of other diseases. The other plate shows 



150 LEUCORRHCEA OR WHITES. 

a laceration of the uterus, which has become inflamed, 
eroded, and is accompanied by profuse leucorrhcea. 
Sometimes leucorrhcea is merely the attendant of a 
poor state of health in a scrofulous person. It may 
be present during a suppression of the menses, or in 
young girls not yet menstruating. It is not uncom- 
mon for leucorrhcea to appear only once a month, and 
may then be said to take the place of the menses. 

This affection causes much distress to many ladies, 
and when the discharge is very copious, it is apt to 
prove weakening to the general health. In little girls 
it may occur from tickling the parts with the hands, 
from pinworms, or illicit intercourse witli children of 
the other sex. It is also common merely as an expres- 
sion of a scrofulous tendency in those girls who are 
growing very fast or are not in vigorous health. 

There is one other form of vaginal discharge at the 
climacteric period or change of life which demands im- 
mediate attention from a physician. Not that it causes 
much trouble to a woman who is likely to postpone 
a consultation for this reason, but because it is one 
of the earliest symptoms pointing to the growth of 
a cancer. This discharge is characterized by being 
watery, offensive, and acrid, causing smarting of the 
parts. 

Another form of vaginal discharge is due to impure 
sexual intercourse, and is highly infectious. It consti- 
tutes a disease in itself, and is called gonorrhoa. It 
develops generally within thirty-six hours after the 
infectious connection, and commences with heat and 
burning in the vagina, with painful and frequent urina- 
tion. These symptoms are soon followed by a copious, 



LEUCORRHCEA OR WHITES. 151 

creamy, yellow discharge from the vagina. This 
disease requires very great care of the person and 
extreme cleanliness. All cloths soiled by the discharge 
should be burned, and the utmost precaution taken that 
not an atom of the secretion touches the eye. Should 
this happen, the eye would become violently inflamed 
and the sight is often destroyed. 

In the treatment of this disease, vaginal douches of 
four quarts of warm water must be used from four to 
five times a day. These douches can be medicated to 
advantage with the following remedies, using them in 
their order as the order of preference. Mix enough 
of the aqueous extract of Hydrastis with the douche to 
color the water yellow. If the discharge continues to 
improve, do not change this medication ; but if all the 
symptoms are quite as bad at the end of forty-eight 
hours, use the following remedy. This is a favorite 
German prescription. Procure at the drug store a six- 
ounce bottle containing equal parts of chloride of zinc 
and water. Mix one tablespoonful of this solution to 
a quart of warm water for an injection. Do not use 
this injection more than once a day. The other daily 
injections can be pure water, or the same as the first 
injection. 

Continue the injections every other day for a couple 
of weeks after the discharge has ceased. Should the 
precise cause of a violent inflammation of the vagina, 
and a thick yellow leucorrhcea like that just described, 
be uncertain, a proper microscopic examination of the 
secretion will establish the diagnosis if the case be one 
of gonorrhoea. 

It should be remembered that leucorrhcea is some- 



152 LEUCORRHCEA OR WHITES. 

times natural in character. It then lasts only a few 
days at a time, perhaps only before or only after the 
menses, or is caused by wearing thin open drawers and 
using a cold privy exposed to draughts of air. Under 
the latter circumstances, warm underwear and the use 
of a chamber or chair in a warm room may be quite 
sufficient to cure the case. 

Persons who have leucorrhcea in consequence of ill 
health require to be built up, and, as their general 
health improves, the vaginal discharge will generally 
cease. A generous diet is of prime importance, such as 
plenty of good beef, milk, and eggs : abstain from tea 
and coffee and all highly seasoned and fried food; 
plenty of fresh air and as much exercise as can be taken 
without fatigue are also desirable. A salt-water bath 
followed by vigorous friction with a towel keeps the skin 
in a healthy condition. Complete sexual rest is essential 
in curing any case of leucorrhcea, and the marital rela- 
tions are to be entirely discontinued; for this reason 
husband and wife should occupy separate rooms. The 
vaginal douche must be used night and morning, first, 
six quarts of warm water to cleanse the parts ; this can 
be followed by a vaginal injection of a quart of medicated 
water, but I prefer to use the same medications in the 
form of an ointment which can be readily applied with 
my ointment injector (Fig. 5, page 84) in the following- 
way : warm the injector by immersing it for a couple of 
minutes in quite warm water ; then fill the end an inch 
and a half full of the proper ointment ; insert the 
injector as far as it will enter the vagina, press up the 
piston and withdraw the instrument ; now insert well 
into the vagina a wad of clean absorbent cotton twice the 



LEUCORRHCEA OR AYHITES. 153 

size of an English walnut with a string attached to it, 
besides wearing a thin napkin over the genitals ; this is 
a precaution to prevent the ointment from escaping and 
soiling the underwear. With the exception of the last 
preparation mentioned below, the medicine can be used 
in the aqueous fluid extract, a tablespoonful to a quart of 
warm water, for an injection night and morning after 
the cleansing douche. If the ointment form is employed, 
the douche is only once used every other day, and is fol- 
lowed by the application of the ointment. In exception- 
ally bad cases it may be necessary to apply it every day. 

The author has devised pastilles for self- treatment 
(Fig. 6, page 84) which contain similar substances and 
are much more convenient than the cerates, though 
a little more expensive. 

Eucalyptus. — For an offensive smelling leucorrhcea. 

Hydrastis. — For bland, yellowish, or creamy leu- 
corrhcea. 

It produces a yellow stain which does not wash out. 

Pinus canadens is (dark extract). — If the discharge 
be obstinate to cure, and of long standing. In using 
this preparation, remember that it produces an almost 
indelible stain on clothing. 

Calendula. — If the leucorrhcea has bloody streaks 
in it. 

Plantago and Boracic acid ointment. — If there is 
much itching or soreness in connection with any of the 
above forms of leucorrhcea. 

Severe lacerations of the womb should be sewed 
together. They cause much suffering ; incurable with- 
out an operation, and if not operated on they are among 
the most common causes of cancer of the uterus. 



154 LEUCORRHGEA OR WHITES. 



Therapeutics. 



Use the remedy in the third preparations, unless 
otherwise mentioned, a dose once in four hours. In 
chronic cases only take the medicine once a day, at 
night on retiring. 

I Arsenicum. — Chronic inflammation of the uterus, 
particularly if profuse flowiug is a marked symptom ; if 
the patient is weak, the discharge thin, and the pelvic 
pains of a burning character; leucorrhcea profuse, 
yellow, thick, corroding} pressive, burning, lancinating 
pains in the ovary, more often the right, extending into 
the thigh, which feels numb and lame, worse from 
motion or bending over ; cutting pains from the abdo- 
men into the vagina; white Leucorrhoea ; acute attack 
from taking cold ; or debility of exhausting disease, 
cancer, kidney, cardiac, or pulmonary disease. 

l\ Belladonna is an invaluable remedy in acute 
inflammation of the uterus. The cervix is very 
sensitive, sw r ollen, and reddened; the mucous mem- 
brane about the os is of a bright scarlet hue. and there 
may be superficial excoriations ; there is much heat, 
dryness, throbbing pain, and bearing down in the pelvic 
organs, more especially in the right side. 

Bryonia. — If the leucorrhcea follows imperfect 
development or retrocession of some skin eruption. 

|| Cole. carb. — It is especially useful for scrofulous 
patients ; perspiration on the least exertion, particu- 
larly about the head; very hungry in the morning, 
acidity of the stomach ; feet feel cold and damp y menses 
too early and too profuse ; leucorrhoea before the 
menses ; milky leucorrhcea, at times profuse, with itch- 



LEUCORRHCEA OR WHITES. 155 

ing and burning. Leucorrhoea in children (Caulophyl- 
lum, Cannab., Sat., and Sepia have also cured leucor- 
rhoea in children) and before puberty. 

Cimicifuga. — The patient is nervous, neuralgic, 
and rather hysterical, especially at the time of the 
menses ; the uterus is engorged ; the cervix eroded and 
hypertrophied ; examination shows a marked sensitive- 
ness of the pelvic organs, especially the ovaries, and the 
left rather more than the right, not from pain but from 
the general hyperesthesia ; headache in the back of the 
head, forehead, over the eyes, or in the eyes ; the pain is 
dull, pressive, and heavy in the eyes, and there is the same 
heavy pressure, with a drawing sensation in the fundus 
of the eyeball ; the pupils dilated ; menses irregular, 
delayed or suppressed, painful menstruation ; nervous 
shuddering and tremors. 

Graphites. — Profuse leucorrhoea of very thin, white 
mucus, with weakness in the back ; leucorrhoea occurs 
in gushes day or night ; abdomen distended ; menses 
delayed, scanty, and pale. Dr. Wahle prescribed it for 
induration and congestion of the cervix ; painful tuber- 
cles on the sides of the cervix ; great weight and lanci- 
nating pains in the lower part of the abdomen and 
uterus. These point to Graphites as a valuable remedy 
for laceration of the cervix with follicular disease. 

I Helonias. — Leucorrhoea with general debility; mel- 
ancholia with a sensation of weight, soreness, and drag- 
ging in the uterus. It may be accompanied by intense 
pruritus, heat, and swelling, with exfoliation of the 
skin. 

I Hydrastis. — Tenacious, thick, ropy, yellow leucor- 
rhoea ; severe erosion of the cervix ; constipation, with 



156 LEUCORRHCEA OR WHITES. 

hemorrhoids and dyspepsia, with a faint or sinking sen- 
sation at the stomach. 

I Kali sulph. has proved an excellent remedy for 
chronic gonorrhoea! infection, purulent leucorrhcea, ach- 
ing in pelvis, and rheumatic pains in the knees. 

Kreosote 3 . — Yellow leucorrhcea with great debility ; 
white leucorrhcea having the odor of green corn ; sore- 
ness, smarting, and burning between the labia and 
thighs, with burning, biting pain; violent itching of 
the vagina and labia; external genitals sometimes swol- 
len, hot, hard, and sore. Menstrual flow intermittent, 
usually copious, accompanied by difficult hearing, with 
roaring and humming in the bead. Cervix tumefied 
with burning, sensitiveness to touch, or coitus and offen- 
sive discharges. Dragging in back relieved by motion. 

I Lycopodium. — Patient looks pale and sallow; 
complains of pressive or full headaches; sloops badly, 
and is always chilly ; feels (nil after eating; "bloating" 
or distention of the abdomen from accumulation of gas ; 
constipation with bard stools ; red sediment in the 
urine. There seems to be a general sluggishness of the 
muscular, venous, and digestive 1 systems, preventing 
the normal peristaltic action of the intestines ; there are 
dryness and burning in the vagina, darting pains in the 
uterine region ; coition is painful. The leucorrhcea may 
be like milk, bloody, or corroding. 

|| Mercurius protoiodide. (Keep it from the light. 
Do not use it in solution.) — Dr. Hughes states that Mer- 
curius cor. is his favorite remedy for scrofulous subjects, 
with erosion of the os, and enlargement of the nabothian 
glands. It is especially valuable in cases of gonorrhceal 
or syphilitic origin, and severe erosions of an unhealthy 



LEUCORRHCEA OR WHITES. 157 

type; profuse greenish, yellow, or purulent leucorrhoea, 
worse at night ; smarting, corroding, itching, and in- 
flammation of the vagina. It is a superior remedy in 
hypertrophy of the uterus, or chronic metritis. 

| Pulsatilla is one of the best remedies for leucorrhoea 
with delayed or scanty menses; the leucorrhoea is thick, 
creamy, or milky, with swollen vulva, painless ; acrid, 
thin, burning ; pressive pain toward the uterus, with 
morning nausea : involuntary micturition at night ; 
frequent, profuse flow of urine ; dyspepsia ; constant 
chilliness ; longing for fresh air ; leucorrhoea after sup- 
pression of the menses. 

I Sepia. — .Enlarged uterus, from venous engorge- 
ment ; prolapsus, with much bearing down ; great dry- 
ness of vulva and vagina, which are painful to the 
touch; leucorrhoea yellow, or like milk, excoriating 
at the climacteric, and especially before the menses ; flat, 
superficial erosions about the os ; tendency to mucous 
catarrh everywhere ; constipation and piles ; a pale, 
sallow complexion, pimples or skin eruptions on the 
face and genitals ; much general itching of the skin. 

I Sulphur. — Is valuable for chronic uterine inflam- 
mation, and reduces venous engorgement by stimulating 
the portal circulation. The leucorrhoea is profuse, yellow- 
ish, and corrosive, burning in the vagina ; the patient 
is melancholic, irritable, and peevish, complains of great 
mental confusion, vertigo, weight on the head, rush of 
blood to the head ; no appetite, or excessive fulness and 
pressure in the stomach after eating ; constipation, or 
early morning diarrhoea; copious and frequent urina- 
tion at night ; numb sensations in hands and feet ; 
burning of the soles of the feet at night. 



CHAPTER XIV. 

INFLAMMATION OF THE UTERUS AND SUR- 
ROUNDING TISSUES. 

Inflammation of the uterus (metritis) is often quite 
independent of inflammation surrounding it (pelvic 
peritonitis when the pelvic peritoneum is involved, 
pelvic cellulitis when the cellular tissue is affected ; 
both forms arc often mixed together). Ladies are, 
however, unable to differentiate these diseases for them- 
selves, and so their domestic treatment must be alike. 
The symptoms of these diseases will be described, and 
the characteristic symptoms of each mentioned, though 
they are sometimes absent. 

Either of these inflammations may be acufc 
chronic; the former stage being comparatively rare in 
a violent form, while the chronic stage often develops 
slowly and insidiously. 

The most common causes of these inflammations are 
childbearing and lack of proper care afterward ; lacera- 
tion of the neck of the uterus during labor; childbed 
fever; chronic congestion of the pelvic organs from 
uterine displacement ; the practice of incomplete sexual 
intercourse, or performing the act within three months 
after confinement ; cold water injections to prevent con- 
ception ; excessive indulgence of the sexual appetite : sud- 
den suppression of the menstrual flow ; and particularly 
frequent or badly treated miscarriages, or abortions. 



INFLAMMATION OF THE UTERUS. 159 

Other less important causes might he mentioned, hut 
enough has heen said to show that most of them prac- 
tically mean lack of ordinary care and unrestrained 
passion. 

The symptoms commonly complained of are back- 
ache and bearing- down sensations in the pelvis ; aching 
in the pelvic organs, sometimes worse on one side ; sud- 
den sharp pain in the vagina is sometimes felt. These 
symptoms are aggravated by walking : passing the urine 
or faeces is not infrequently painful ; the woman feels 
dragged out and all her duties become burdens to her ; 
headache in the nape of the neck, dyspeptic symptoms, 
and painful menstruation often follow ; the marital 
relations become painful and intolerable, indeed they 
must be entirely discontinued to cure the case ; leu- 
corrhcea commonly attends chronic cases. Should the 
inflammation be very extensive the patient is obliged to 
limp about, and rest at night with the limb drawn up a 
little. Cases of acute inflammation of the tissues sur- 
rounding the uterus often begin with chills, high fever, 
much pelvic pain, sensitiveness, and sometimes vomit- 
ing ; the region of the bladder is often so tender the 
touch of the hand or weight of the bedclothes can- 
not be endured. Under such circumstances a physician 
must be summoned Avithout delay. Recovery is often 
slow, but relief begins as the fever goes down ; should 
the fever keep up and continue unabated after the third 
day from the chill, and the pain in the pelvis assume a 
throbbing, pulsating character, an abscess in the pelvis 
is likely to form ; this is most apt to occur in poorly 
nourished, scrofulous women. 

The various forms of inflammation mentioned are 



160 INFLAMMATION OF THE UTERUS. 

curable, but often require much time and considerable 
skill on the part of the physician. 

When the symptoms are not very severe, a woman 
can often give herself much relief by the following local 
treatment and medicines : — 

Hot bran or hop bags applied over the bladder often 
relieve the pain, and should be renewed as soon as they 
become cool ; equal parts of turpentine and white of egg 
applied over the painful spots is another application 
which can be used to advantage; hot hamamelis com- 
presses are preferred, by some women, to any of the 
external applications just mentioned. 

Hot-water vaginal douches are to be relied on chiefly 
to diminish the inflammation and congestion; these 
should be used, six quarts at a time, at a temperature 
of 112° Fahr., night and morning, with a fountain 
syringe (seepage 47 i. It is necessary to take them while 
lying on the back with the hips raised a little higher 
than the shoulders to help the blood flow from the 
pelvis up into the body; the tube from the bedpan 
which needs a firm support so it will not tilt up, can 
carry the water to a pail at the side of the bed and thus 
avoid running the water over in bed. An ordinary 
cleansing douche may be taken while sitting on the 
edge of the water-closet, but when the heat of the water 
is necessary for its therapeutic effect, the recumbent 
position becomes absolutely necessary. The action of 
the hot water is well illustrated by the shrivelled 
appearance of the fingers after working in hot water, 
as in .doing the family washing. 

It is not uncommon for a person to become a little 
faint who is not accustomed to taking such douches ; 



INFLAMMATION OF THE UTERUS. 161 

this need cause no alarm, and, as a rule, soon ceases. 
Hot douches generally are easily borne (cold vaginal 
douches are never safe to use), but occasionally when 
the ovaries are affected a hot vaginal douche will increase 
instead of relieving the symptoms. It is needless to 
remark that under such circumstances the douches are 
not to be taken. 

After taking the douche just described, the patient 
can use to advantage one of the following vaginal injec- 
tions : — 

If there is much pain in the pelvis, aching in the 
right side more especially, much sensitiveness externally, 
bearing down in the pelvis and painful urination, add to 
a pint of warm water four tablespoonfuls of glycerine 
and one tablespoonful of Belladonna tincture ; stir them 
together and use for a vaginal injection after each hot- 
water douche. If throbbing headache, dilated pupils, and 
a flushed face appear after this injection, only mix one 
half the quantity of Belladonna for the next injection. 
{Belladonna is poisonous when taken internally. The 
bottle containing it must be plainly marked '-Poison" 
and kept separate, away from other medicines, to pre- 
vent any mistakes. It is safe if used as indicated 
above.) 

If the case is not so acute in character, the pains 
dull, aching, and are chiefly in the groins, mix two 
tablespoonfuls of glycerine and an equal amount of 
hamamelis, and after each douche inject it slowly in the 
vagina with a piston syringe. 

If the trouble is of long standing and there are dull 
pains in the pelvis with general prostration, use with one 
pint of warm water, four tablespoonfuls of glycerine 



162 INFLAMMATION OF THE UTERUS. 

and two tablespoonfuls of the compound tincture of 
iodine ; mix and inject it in the vagina after each 
douche. If no smarting is produced, a little more iodine 
should be added ; if there is much smarting or burning, 
the amount of iodine should be reduced. Iodine must 
not be measured in metal, as it will quickly corrode and 
spoil it. An amount of water corresponding to the 
desired quantity of iodine can be measured in a glass, 
and a corresponding amount of iodine can be poured 
out in another glass till the eye perceives the quantity 
is the same. A few drops, more or less, is of no con- 
sequence. Instead of iodine, the addition to the glycer- 
ine of icthol, enough for a ten per cent solution, has 
been highly praised. 

The author's pastilles are very 
helpful and convenient in treating 
inflammatory disorders of the pel- 
77, ,, ,.,, vie organs. They will cure a case 

Fig. 11. Sonthwtck's Pastille. & 

more quickly than the above applications. 

A mild current of electricity, as described in the 

chapter on uterine displacements, can often be used to 
advantage. Leucorrhoea attending these inflammations 
is described in the chapter on that subject. 

The importance of rest in treating these various 
inflammations cannot be overestimated. Even though 
a patient may feel quite well, she must not presume on 
her strength. When a woman has once suffered from 
pelvic inflammation, she will be subject to attacks of 
it again from comparatively slight causes. As long as 
there are any symptoms of local inflammation, rest is 
essential, particularly at the menstrual period. A ham- 
mock is one of the most comfortable things for the 




INFLAMMATION OF THE UTERUS. 103 

patient to lie in, as the sinking of the hips below the 
level of the shoulders and heels relaxes the abdominal 
muscles. Marital relations are a positive injury to the 
patient, and must not be practised. The sewing ma- 
chine, walking, riding, or any exercise which aggravates 
the pain, is to be positively forbidden, and high-heeled 
shoes in particular. 

Therapeutics. 

Take the third preparation, unless otherwise men- 
tioned, once in three hours. 

I Aconite. — A valuable remedy in the stage of con- 
gestion (Ye rat r. vir.), especially when it results from 
cold ; high fever ; hot, dry skin ; great thirst ; much 
anxiety and restlessness. Vomiting is sometimes present, 
and cutting pains in the abdomen. It should be given 
in the lower potencies, in severe cases (lx or 2x) as 
often as once in fifteen or twenty minutes, till the fever 
begins to subside and perspiration commences. It is 
most useful at the time when the hot -water douche is 
indicated. Dr. Jousset recommends twenty to thirty 
drops of the mother tincture to be taken in twenty-four 
hours (i. e., three to five drops once in four hours), for 
very acute and severe cases of pelvic peritonitis. 

I Apis?* trit. sometimes will stop suppuration. It 
is good for relapsing abscesses, and is one of the most 
useful remedies to stimulate the absorption of exuda- 
tion. Apis is to effusion in the cellular tissue what 
Bryonia is to effusion of serum in the peritoneum. 
Burning, stinging pain in region of the uterus or ovaries, 
especially the right ; great tenderness over the uterine 
region, with bearing-down pain ; leucorrhcea and pain- 



164: INFLAMMATION OF THE UTERUS. 

ful urination ; menses diminished or suppressed ; ten- 
dency to dropsy. 

Arsenicum. — It is adapted to both acute and chronic 
cases; burning, throbbing, lancinating pains in the 
uterus ; similar pains extending from the abdomen or 
ovaries, more especially the right, into the uterus, 
vagina, or thighs, which feel numb or lame, worse 
from motion or sitting bent over; leucorrhcea profuse, 
thick, yellowish, corrosive : great restlessness, prostra- 
tion, thirst, but worse from drinking cold water ; 
aggravation of symptoms about midnight, if the symp- 
toms are of a typhoid type. 

I Belladonna. — Acute cases. Arterial congestion of 
the uterus; on vaginal examination there is marked 
pulsation in the pelvic organs, a sensation of heat, and 
great sensitiveness; there is much bearing down, back- 
ache, thro&bing headache, face flushed, and oven 
delirium; the discharge feels hot to the patient ; monor- 
rhagia, with profuse, hot, rod flow; menses too early. 

Calcarea carb. — Scrofulous diathesis, chronic < 
after confinement ; menses too early, too long, and too 
profuse; milky leucorrhcea ; prof use perspiration from 
the least exertion, chiefly about the head ; feet feel c<>!d 
and dump; acidity of the stomach: the patient feels 
worse during and after coition. 

Conium. — Tympany of the abdomen, especially at 
the menstrual epochs; severe pain in the abdomen, witli 
chilliness; violent cutting pains in the abdomen; ach- 
ing and bearing-down pain in the hypogastrium ; leu- 
corrhcea of white, acrid mucus, causing a burning 
sensation, and preceded by colic-like pains ; frequent 
urination at night ; burning or smarting in the urethra 



INFLAMMATION OF THE UTERI"-. 165 

during and after micturition : induration of uterus. 
, ovaries, or breasts : sweUm - ss of the mamma 

ire the i - - 

| Mac rot in. — The active resinous portion of cimici- 
fuga | compare indications for eimieiiuga. page I 
also called actea racemosa ; eases of subacute pelvic 
peritonitis in rheumatic women, subject to pleurodynia, 
intercostal rheumatism, etc. : painful condition of the 
spinal muscles : if the patient is in an anxious, wakeful, 
nervous, irritable condition : takes no interest in any- 
thing : despondent, sleepless : sutlers from pain and 
distress in the pelvis : and the menses are scant} 
irregular, with increased nervousness at the time of 
their appearance : uterus engorged and sensitive : back- 
ache relieved from lying down. 

I M s. — It is particularly indicated by profuse 

g enish, yellow, or purulent leucorrhcea, worse at 
night : smarting, corroding, itching, and inflammation 
of the vagina : sensation of deeply seated soreness in the 
uterus, with dragging sensations : easy perspiration : 
very sensitive to draughts of air. chilliness, and general 
aggravation of the symptoms at night : beginning of 
pelvic abscess 

| Sabina. — Arterial congestion of the uterus : hem- 
orrhage, rectal or vesical irritation, or both at the same 
time: hemorrhage, from the uterus, in par* 
worse from motion ; blood dark and clotted, from loss "J 
in the uterus, after abortion or parturition, with 
pain in back extending to pubis; menses too proj 

early, and last too long. Metritis after parturition. 
or abortion at about the third month : sexual desire 
almost insatiable. It is e-p^/ially suitable to what 
might be termed subacute metrir 



166 INFLAMMATION OF THE UTERUS. 

1 1 Secede is the great remedy for inflammation after 
miscarriage or childbirth, both for the ordinary cases 
characterized by an atonic condition of the uterus, and 
the severe ones where gangrene threatens, with a 
general adynamic condition of the system ; uterine hem- 
orrhage, worse from the least motion ; discharge black, 
fluid, and very fetid. After an abortion the uterus 
does not contract ; thin, black, offensive discharge ; 
siqypressed discharges, followed by metritis: extreme 
debit it if, prostration, and restlessness. Tlic lower dilu- 
tions of a, fresh preparation arc the best. 

\\ Sepia. — Venous congestion of the uterus and 
pelvic tissues ; prolapsus uteri ; pain in the uterus, and 
such severe bearing (ton-,, that the patient feels as if -he 
must cross the limbs t<> prevent protrusion of the parts; 
leucorrhcea yellow, milky, excoriating, worse before the 

menses; itching eruptions on the skin ; yellow saddle of 

discoloration over the bridge of the nose ; excessive 
prostration, exhaustion, and faintness ; offensive, tur- 
bid, clay-colored urine, with reddish sediment. 

| Sulphur. — An excellent authority recommends the 
use of this remedy intercurrent lv in different dilutions, 
during the treatment of chronic cases, no matter what 
other medicines are given. Should the well-known 
general symptoms of Sulphur be present in addition to 
the local ones, this would be all the more important ; 
menses too late, too profuse, bid of too short duration ; 
blood thick, dark, sour-smelling, and excoriating ; pro- 
fuse, yellowish, corrosive leucorrhcea ; burning in the 
vagina, and itching of the genitals. 

Silicea. — Chronic pelvic abscess with fistulous open- 
ing and large amount of thin pus. Constant chillin 



INFLAMMATION OF THE UTERUS. 167 

fever, with violent heat in the head, worse at night ; 
profuse sour or offensive perspiration at night ; much, 
weakness and prostration ; great constipation, constant 
but ineffectual desire for stool ; stool expelled with 
difficulty, or when partially expelled slips back ; head- 
ache and nervous symptoms, which seem to depend on 
the loss of strength from suppuration. 

I Terebinth in a 2x is a remedy in which Dr. Ludlam 
has great confidence for puerperal and post-puerperal 
pelvic peritonitis. When there is great weakness and 
prostration, excessive distention of the abdomen, and a 
disposition to hemorrhage, which makes it useful in 
peritonitis, associated with pelvic hematocele. The 
violent drawing, burning pains in the region of the 
kidneys, and scanty and bloody or even suppressed 
urine, with distressing strangury, are excellent addi- 
tional indications, should they be present. 

Veratrum viride 2x has been warmly recommended 
for the acute stage of pelvic cellulitis or peritonitis in 
lying-in women, with symptoms similar to those calling 
for aconite. Great cerebral congestion ; pupils dilated ; 
face flushed ; violent nausea and vomiting, with cold 
sweat ; severe pain and soreness just above the pelvis ; 
heart-beats loud and strong, with great arterial excite- 
ment, but the respirations are very slow. The doses 
must be frequently repeated till there is some ameliora- 
tion of the symptoms. 



CHAPTER XV. 

INFLAMMATION AND NEURALGIA OF THE 
OVARIES. 

Inflammation of one or both ovaries (ovaritis) is 
not uncommon and may be associated with other 
diseases of the pelvic organs, usually of an inflam- 
matory character. It occurs in both the acute and 
chronic forms, the Latter being the more frequent. 
When the disease has lasted for a Long time, the ovary 
is apt to become Larger and harder ; the ( rraafian follicles 
and the ova become destroyed or injured to Bueh an 
extent that ovulation cannot take place. This will 
cause permanent sterility or barrenness. 

The following are the more common causes of 
inflammation of the ovaries : childbed fever, sudden 
suppression of the menses, as from wetting the feet 
during the flow, extension of inflammation from the 
uterus, the use of cold water or strong astringent 
vaginal injections to prevent conception or to suppi 
leucorrhcea, and abuse of the sexual functions. Lastly, 
a comparatively frequent cause, not the fault of the 
patient but of her physician, who applies nitrate of 
silver to the uterus for so-called ulcerations " to burn the 
ulcer out," a barbarous practice which has made many 
a woman an invalid. 

The symptoms of ovaritis are often obscured by 
other conditions, and other diseases may cause symp- 
toms like those of ovarian inflammation. Pain in the 



INFLAMMATION OF THE OVARIES. 169 

ovarian region, i. e., a little to one side or the other of 
the bladder near the groin, is quite common. This 
may be acute in character and extend up into the 
abdomen or down the thigh. With this severe pain the 
ovarian region is likely to be sensitive to the touch, and 
the patient is likely to lie on her back with the limb 
drawn up on the affected side. In cases of longer 
duration, the pain is of a dull aching character, 
aggravated by walking. The menses are often irreg- 
ular, painful, and profuse. There may be pain during 
movements from the bowels, and the marital relations 
are so painful as to become unbearable. Nervous 
or hysterical manifestations are not uncommon. A 
peculiarity of all these symptoms is their aggravation 
at the menstrual period. 

Many of these symptoms occur when the neck of 
the uterus is torn or diseased, so that they cannot be 
taken as absolute proof of ovaritis. A careful exami- 
nation by a well-informed physician will be necessary 
to establish the diagnosis. 

A cure is usually obtained if the ovaritis has not 
lasted too long. When it has been caused by the use 
of nitrate of silver, the disease is very hard to cure. 
There are four things of great importance to be observed 
in treating this affection : a generous diet of nutritious 
food to maintain a high standard of health, avoidance 
of all exercise which increases the pain, rest in bed 
during the menstrual period, and, most important of 
all, there must be no sexual indulgence or excitement. 
Chronic constipation should be removed if possible, as 
this increases the venous congestion of the pelvic 
organs. 



170 INFLAMMATION OF THE OVARIES. 

The external use of a hot hop-bag, dry hot bran- 
bag, compresses of hamamelis mixed with an equal 
amount of water, wormwood and alcohol, or camphor 
and turpentine, equal parts if it does not burn too 
much, and the inunction of belladonna ointment will 
give temporary relief. They cannot be depended upon 
to cure the case. In acute cases, copious vaginal 
douches of hot water (six quarts, 112°), followed by a 
vaginal injection of half a pint of warm water, three 
tablespoonfuls of a strong extract of hamamelis (Pood's 
extracts and the same amount of pure glycerine, will 
often be very beneficial. It should be employed night 
and morning. The use of opium or morphine in any 
form is to be scrupulously avoided. 

Therapeutics. 

The medicines arc to !»<• used in the third decimal 
preparations, unless otherwise specified : a dose i> to 1>»- 

taken every hour in acute cases till better, and the 

medicine should housed ,-it least twenty-four hours be- 
fore changing it, as immediate results may aot be felt. 
In chronic cases a dose night and morning is sufficient. 
Aconite has been considered a good remedy for 

puerperal ovaritis in alternation with Arnica, it there 
has been much bruising, as after long labors or opera- 
tions. It is useful for acute ovaritis with painful 

urging to urinate, high fever, and when it follows 
sudden suppression of the menstrual flow ; skin dry 
and burning hot ; extreme thirst for cold water ; red- 
ness of the face, sometimes changing to palem 
heat with thirst ; hard, full, and frequent pulse ; 
anxious impatience ; unappeasable ; beside herself ; t 



INFLAMMATION OF THE OVARIES. 171 

ing about with agony. Ovaritis from sudden and 
severe chill, or after fright or vexation ; fine stinging 
or binning pains with great restlessness. Some physi- 
cians alternate it with Bryonia. Generally speaking, 
Aconite is inferior to Belladonna, which has a more 
specific action on the ovaries, and should be used if 
Aconite does not soon relieve the pahi and fever. 

II Apis. — Either acute or chronic ovaritis, especially 
in the right side. The symptoms calling for it are : 
enlargement of the right ovary, with pain in the left 
side of the chest, and cough : burning, stinging pains 
in the ovaries, worse at time of menses : tenderness 
over the bladder : urging to urinate : ovaritis with 
suppression of the menses : scanty and high-colored 
mine, burning when passing : absent-mindedness, and 
extreme sleepiness. 

Arsenicum. — Burning, tensive, stitching, pressive 
pains in the ovaries, especially the right, sometimes 
extending into the thigh, making it feel numb and lame. 
worse after midnight, from motion and from sitting 
bent : corrosive leucorrhoea : backache : the pain is 
relieved by the application of heat : the patient is very 
irritable, restless, and very thirsty for cold water, 
drinking often, but little at a time : cold water lies like 
a stone in the stomach, or is immediately ejected : 
great prostration and restlessness, especially of the 
lower limbs : burning in the urethra while passing 
urine, which is- scanty ; abdomen distended and pain- 
ful : violent burning pains with intolerable anguish. 

II Belladonna. — The chief remedy for the treatment 
of acute ovaritis, and also useful for the chronic form ; 
but immediate results in the latter will not be obtained. 



172 INFLAMMATION OF THE OVARIES. 

It is very valuable when the peritoneum is involved 
either with the puerperal state or independent of it, 
The symptoms appear suddenly with marked signs of 
local congestion ; severe pain of a clutching, clawing, 
stabbing, or throbbing character in the ovarian region, 
especially the right, with great local sensitiveness; 
cannot bear the least jar; painful bearing down ; high 
fever; thirst; throbbing headache; flushed face, and 
even delirium in post-partum cases; discharges feel 
hot to the patient ; great pressure downward in tin 
genitals; menses too early and too profuse; bright red 
or thick, decomposed dark red blood; abdomen dis- 
tended, painful, and very sensitive to touch, with here 
and there pressive, cutting pains ; wry sensitive to noise 
and smell; retention of urine, passing only drop by 
drop; less often scant v. dark urine passed with 
difficulty; pains come and go suddenly, worse after 
three in the afternoon, and again after midnight. It i- 
also useful for mild cases, worse during the menstrual 

periods. 

Bryonia.— Ovaritis of rheumatic origin. It seems 
to be best suited to cases of moderate severity, with 

stitching pains, worse on coughing, inspiration, and 
motion; pain shooting or extending to the hips; obsti- 
nate constipation, stool la rge, hard, and dry. expelled 
with great effort ; better from lying on the painful side. 
Cantharis.— Patient cannot breathe freely on ac- 
count of the stitching, pinching pains- in the ovarian 
region; cutting, burning pains in the ovaries; bear- 
ing down in the genitals ; violent pains in the bladder, 
with frequent urging and great tenesmus; excitement 
of the sexual instinct. 



INFLAMMATION OF THE OVARIES. 173 

| Colocynth. — Ovaritis, pain more in the left rather 
than the right side, complicated with peritonitis, espe- 
cially when it follows an abortion ; numbness in the 
limbs ; cramp-like or boring tensive pain in the ovaries, 
causing the patient to double up, with great restlessness ; 
pain extends down the inner side of the thigh. There 
is much pain in the abdomen, and sometimes diarrhoea, 
and straining of the bladder to urinate, with scanty 
urine. The ovaritis calling for Colocynth is charac- 
terized by the severe colicky pains in the left ovary, 
relieved by pressure. The smell of cooking food causes 
nausea. 

Conium. — Chronic ovaritis; induration and en- 
largement of the ovaries, with lancinating pains ; 
soreness and swelling of the breasts before the menses ; 
menses scanty or absent ; leucorrhoea thick, milky, with 
labor-like pain, or of white acrid mucus, causing 
burning ; offensive eructations, vomiting, sour rising, 
or violent pain in the stomach ; severe itching deep in 
the vagina ; much difficulty in voiding urine ; it flows, 
then stops, then flows again. 

I Laches is has been used with much benefit for 
chronic enlargement with abscess or induration of the 
ovaries ; it is also excellent for chronic or subacute 
ovaritis, complicated by metritis, especially if it occurs 
at the change of life ; menses feeble and scanty, but 
regular ; labor-like pains before or during the flow, 
especially in the left ovarian region, cutting uterine or 
ovarian pains like a knife thrust into the abdomen, 
relieved by flow of blood ; copious greenish leucorrhoea 
which causes smarting ; great sensitiveness of the 
region of the bladder ; cannot bear tight clothing about 



174 INFLAMMATION OF THE OVARIES. 

the waist, not that it causes pain, but it is exceedingly 
uncomfortable ; beating in the anus as with little 
hammers ; Plaiina follows Laches is well. 

Macrotin is preferred by some to Cimicifuga in 
ovarian disorder ; ovaritis which seems to be due to a 
metastasis of rheumatism. The pains shoot up to the 
side ; the hypogastrium is very sensitive to pressure, 
with a bearing-down sensation ; the menses are 
irregular, delayed, or suppressed; great nervousness or 
chorea at time of the menses ; infra-mammary pains, 
worse on the left side. 

| Mercurius. — This is one of the most important 
remedies for ovaritis complicated with peritonitis, 
especially in the puerperal state. to averl the formation 
of an abscess. There is deep sore pain in the pelvis, 

dragging in the Loins, sensation of weakness in the 
abdomen ; or the abdomen may be dish nd\ d and painful, 
with a bruised sensation, or cutting, stinging pains, 
worse at night ; frequent urging to urinate; perspira- 
tion at night without relief; extreme sensitive] 
draughts of cold air; ovarian pains shoot or extend 
toward the hips; Leucorrhoea always worse at night; 
itching, burning, smarting, corroding with rawness; 
-real weariness and prostration ; trembling of the 
muscles ; pains worse at night, from the heat of the 
bed and during perspiration. 

\Platina. — Sexual desire excited; ovaritis with 
burning pains in paroxysms; numbness in the limbs ; 
menses too early and profuse {Pulsatilla the revers 
flow dark ; leucorrhoea only in the daytime ; hysteria and 
melancholia ; painful sensitiveness over the uterus : pit Be- 
ing and bearing down in the abdomen extending into 



NEURALGIA OF THE OVARIES. 1 \ 5 

pelvis. Chronic cases when there is reason to suspect 
induration of the ovaries. If Platina seems indicated, 
but mental symptoms do not correspond, and it fails to 
cure. Dr. Hering recommended Palladium. The latter 
seems to act best on ovarian affections of the right side. 

Plumbum acet.* x - — Violent vomiting with each men- 
struation, with abdominal colic centring at the umbil- 
icus, and pains all over as if bruised. It cured a case 
after two years of suffering following a fall from a 
carriage. A well-known surgeon had advised removal 
of the right ovary in this case. 

Sepia is a good remedy for chronic ovaritis, but the 
indications for it are scanty, and pertain to uterine 
rather than ovarian disease : dull, heavy pains in the 
ovaries with pain in the uterus, and sensation of much 
bearing down in all the pelvic organs; yellow, milky. 
excoriating leucorrlwea, worse before the menses: urging 
to urinate, with turbid, clay-colored, or reddish sedi- 
ment ; constipation, and sense of goneness or emptiness 
in the stomach and abdomen. 

I Thuja is of great value for left-sided ovaritis, worse 
at each menstrual epoch ; distressing pain, burning 
when walking or riding, obliging the patient to lie 
down ; putting of the abdomen in places here and there. 
It is also good for chronic ovaritis, with a suspicion of 
venereal taint. There is a tendency to the formation 
of seedy pediculated warts on the skin, persistent sleep- 
lessness, morning diarrhoea, and severe headache. 

Ovarian Neuralgia. 

Ovarian neuralgia, i. e.. neuralgia of the ovaries, is 

a very painful affection, and, as a rule ; is symptomatic 



176 NEURALGIA OF THE OVARIES. 

of some other condition. The more common causes 
are a poor state of health, especially in a woman 
subject to neuralgia, rheumatism, or hysteria ; uterine 
displacement ; laceration of the uterus ; excessive or 
incomplete sexual intercourse, and an ungratified sexual 
appetite. 

The pain is severe, comes on suddenly without chills 
or fever, and without any warning. It varies in 
intensity and locality in different women ; not infre- 
quently comes and goes, and gradually p way ; it 
is usually in one ovary, extending down tin 4 thigh. 
fixed in one spot, or radiating from it up into the abdo- 
men. It is of an intense, lancinating, or cramp-like 
character, and not infrequently attended with vomiting, 
tainting, hysterical spasms, and doubling-up of the body 
on the affected side, which is exceedingly sensitive to 

fche slightest touch. 

No one ever dies as the direct result of ovarian 
neuralgia. On the other hand, it is a difficult affection 
to cure, unless the exciting cause can he removed. 

General Treatment. — The first object is to build 
the patient up to the maximum of health. Outdoor 
air, exercise, good food and plenty of it. pleasant sur- 
roundings, mental rest, freedom from care, and regula- 
tion of sexual matters, are all important. Marri 
and childbearing are often beneficial. It is hardly 
necessary to say that the cause must be carefully sought 
out, and removed if possible. Flannel underwear should 
be worn; and, in addition, a pad of uncarded wool, 
basted to the underclothing over the hypogastrium, will 
act as a preventive in protecting that region from cold. 
Closed drawers are better than open ones for the same 






NEURALGIA OF THE OVARIES. 177 

reason ; and the feet must be kept warm and dry by 
thick shoes and stockings. 

At the time of the attack, heat in the shape of hot 
flannels, or of a hot hop or bran bag, may palliate the 
pain. Counter irritation in the form of a mild mustard 
plaster, or camphor and turpentine, or equal parts of 
turpentine and the white of egg, applied over the seat of 
pain, sometimes relieves. Besides this, a vaginal injec- 
tion can be used, of hot water, glycerine, and the watery 
extract of hamamelis, in equal parts ; or, instead of the 
latter, the strong tincture of Aconite, preferably the 
Aconitum uncinatum, in the proportion of about ten per 
cent. Some prefer to apply the Aconite, either alone 
or mixed with an equal quantity of chloroform, on the 
skin over the site of pain. If the rectum be loaded with 
fecal matter, no time should be lost in giving an enema 
of very warm water, and removing a possible cause of 
pain. 

Medical Treatment. — In the intervals between the 
attacks, constitutional remedies are necessary to dispel 
the tendency to recurrence. It is of little use to give 
them, unless the physician's directions be strictly and 
perseveringly observed. Chronic cases may require 
months of faithful treatment. 

Therapeutics. 

Use the third decimal preparation, unless otherwise 
specified, a dose every twenty minutes if the pain is very 
severe ; otherwise, take the medicine once in one or two 
hours, according to the severity of the case, and always 
take it less often when improvement has commenced. 
In chronic cases the remedy should be taken night and 



178 NEURALGIA OF THE OVARIES. 

morning between the attacks of pain. (Compare the 
remedies for ovaritis.) 

Arsenicum. — Violent burning pain in the abdomen, 
with great anguish, rolling and tossing about ; abdomen 
distended and painful; drawing, stitching, burning, or 
tensive pain in the ovaries, the right rather than the 
left. (See page 171.) 

{Atropine (the active principle oi. Belladonna). — 
The same symptoms as those which would call for 
Belladonna; intense clawing, clutching pain in the 
uterine region, with great sensitiveness to touch, and 
bearing-down sensations; face flushed, pupils dilated. 
sometimes delirious. (Seepage L71.) 

| Colocynth. — Intense pain in the inguinal region; 
boring, tensive pain in the ovary, more especially the 
left one; patient is doubled up with pain, and seeks 
relief by pressing the abdomen against something hard, 
as a table, chair, or bedpost ; pain may concentrate in 
the pit of the stomach, with eructations, nausea, or 
vomiting. Attacks caused by vexation, or eating 
potatoes. (See page 17:;. i 

Macrotin. — A good remedy when the attack seems 
due to a metastasis of rheumatism in nervous women at 
the climacteric. The patient is irritable, melancholic, 
and subject to infra-mammary pains in the left side. 
(See page 174.) 

Magnesium jihos. — Severe, darting, lightning-like 
pains in the ovarian regions, without fever or inflam- 
matory symptoms. 

Naja has proved very serviceable for violent, cramp- 
like pain in the region of the left ovary, with violent 
palpitation of the heart. Dr. Hughes states that "it 



NEURALGIA OF THE OVARIES. 179 

has become my own favorite medicine for obscure 
ovarian pain, not frankly inflammatory." 

Xanthoxylon. — Violent, agonizing pains in the loins 
and lower part of the abdomen, and especially in the 
left side, which extend through the internal abdominal 
ring, and down on the inner anterior surface of the 
thigh. The writer knows of one case, characterized by 
these symptoms, which was promptly cured by this 
remedy. Her agony was so great that she could hardly 
be held on the bed, making it necessary to keep her 
partially under the influence of ether for some hours, 
till this remedy was given with remarkable effect. 

II Valerianate of Zinc. — Chronic orarcdgia in hyster- 
ical women. It is also useful as a constitutional remedy 
to break up the tendency to the attacks. Useful as this 
remedy is for various kinds of neuralgias, the indica- 
tions for it have not yet been precisely defined. 



CHAPTER XVI. 
TUMORS OF THE GENERATIVE ORGANS. 

A tumor means any growth or bunch of tissue 
differing from the ordinary and natural anatomical 
structures. It may be smaller than a pea, or be larger 
than an ordinary sized pail, and of course may be of 
much or of no importance. 

All tumors are divided into two greal classes : those 
which do not return when removed, and do not in 
themselves destroy the lite of the patient ; and those 
which act in exactly the contrary manner, and come 
under the common name of cancer, which includes 
several varieties. This Lasl class is called malignant, 
and will be treated of by itself in the next chapter, on 
"Cancer." In this chapter only the firsl olas>. called 
benign tumors, will he mentioned. These, it is to be 
remembered, do not return when removed, and, except 
by secondary effects, never cause death. 

They may he classified as follows : — 

Myomas, often called in- 
correctly fibroid tumors. 
Polypii, which project into 
Tumors connected with J the cervical canal. 

the uterus. Inflammation of the lining 

membrane of the uterus, with 
little wart-like growths on it. 



TUMORS OF THE GENERATIVE ORGANS. 



181 



Tumors outside of 
uterus. 



the 



Ovarian tumors, Cysts of 
the broad ligament. 

Enlargement of the Fallo- 
I pian tubes from salpingitis. 

I need hardly emphasize the necessity of consulting 
a physician without any delay when there is reason to 
believe a tumor is present. 

The great characteristic symptom of tumors of the 
uterus, with the exception of myomas on the outside of 
the uterus (subperitoneal), is 
that they all produce profuse 
flowing. The loss of blood is 
most marked with submucous 
myomas. The latter may con- 
sist merely in prolonged and 
profuse menstruation, or there 
may be in addition flowing 
from slight causes between the 
periods. This may come in 
gushes, without any warning. 
I well remember a patient to 
whom I was called, who for 
two years did not dare leave 
her house, and seldom went 
downstairs on account of pro- 
fuse flowing in gushes without 
any warning. I ascertained by a simple examination 
that she had quite a large tumor in the cavity of the 
uterus. I removed it without any difficulty. She had 
no pain afterward, no return of the hemorrhage, and 
is in fact a well woman. This case is only one of 
many I might mention. 




Fig. 12 
Illustration of forms of uterine 
myomas : 
A .— Subperitoneal myoma. 
B.— Interstitial myoma. 
C. — Submucous myoma. 
D. — Polypus in the cervical 
canal. 



182 TUMORS OF THE GENERATIVE ORGANS. 

Myomas (fibroids) most commonly develop at the 
change of life, and may be present without any enlarge- 
ment of the abdomen. They may weaken a patient and 
make her miserable from the flowing ; but if the change 
of life is once past, they almost always cease to grow, 
and often shrink up or even disappear. The object <>f 
treatment then, particularly for large myomas, is to help 
the patient along and check the hemorrhage till it returns 
no more : i. e., till after the change of life. I have 
been able to succeed in doing this in nearly all ca- 
Another very characteristic symptom of largo fibroid 
tumors is that they are exceedingly hard, and when feli 
through the abdominal wall it is like touching a stone. 

A distinguished French physician has had great 
success in treating these tumors by electricity. En- 
couraged by the wonderful results he reports, I 
procured the apparatus for the purpose, and have used 
it with good results. Bui electricity cannot he used 
for all eases; it requires great care and experience 
use it in treating tumors, or harm instead of good will 
follow. The method is as yet too little tested to 
write with authority on tin 4 subject. It i< enough to 
say, however, that remarkable results appear to have 
been achieved. 

Large tumors cause much discomfort from pressure 
on the blood-vessels and intestines; bloating in the 
abdomen, constipation, dyspepsia, and backache are 
common symptoms ; while they are no doubt very 
uncomfortable, they do not threaten the otherwise good 
health of the patient. This is important to remember, 
so that a woman need not worry in the- least about 
herself. Should an operation become necessary, which 



TUMORS OF THE GENERATIVE ORGANS. 1S3 

is very seldom, it is of the greatest importance to have 
a first-class gynecologist who has made a special study 
of such operations. Under these circumstances it is 
much safer to go through the operation than many of 
the diseases people have without thinking much about 
it ; eighty-five persons out of a hundred should recover. 
The time necessary to remain in bed varies from three 
to five weeks. 

Many theories have been advanced to account for 
myoma s ^fibroid tumors). We know they are common 
in women of the African race, much more so than in 
the white race. Formerly it was thought that unmar- 
ried women were more subject to them than the 
married, but more careful compilation of statistics 
shows the contrary. We are not yet in a position to 
affirm the precise causes of these tumors. 

The treatment of such growth should be left to the 
attending physician. In case of flowing, the same rules 
are to be observed, and the same remedies are to be 
taken, as for profuse menstruation. (See page 107.) 
There is very little to be gained by any vaginal injection 
or external application. Some physicians think they 
have seen much benefit from myro-petroleum spread 
on linen and worn as a large plaster on the abdomen 
over the tumor for some months ; if this plaster causes 
much irritation and soreness of the skin, it can be tem- 
porarily discontinued for a few days. 

The reader is referred to the chapter on "Menor- 
rhagia and Metrorrhagia," page 106, for the use of 
remedies besides those mentioned here, which may 
apply a little more strictly to the treatment of myomas. 
In case of flowing, the remedy should be taken every 



184 TUMORS OF THE GENERATIVE ORGANS. 

hour in the third decimal preparation, and, unless other- 
wise stated, take the remedy before each meal. 

Therapeutics. 

| Aurum natronatum murtaticum**. — Cured one large 
fibroid tumor in one of my patients. Not much is 
known positively of the remedy. It seems best adapted 
to patients complaining of sticking, sharp pains in 
various parts of the body, and those who are very 
despondent and have suicidal tendencies. 

|| Calcarea iodide — Patients having a scrofulous 
diathesis; menses too earl//, too long, and too profuse; 
rnilky leucorrhcea, with itching and burning; acidity of 
the stomach ; profuse perspiration in the morning, and 
on slight exertion. It musl be prepared fresh, and kept 
in a blue glass bottle, out of the Light. The writer has 
bad two Cases in which Colcarea carb., 3x hit., seemed 
to diminish the size of the tumor to a marked 1 degree. 

( )ne was about the size of a COCOanut, in the left >i<le of 

the pelvis, and seemed to partake of tlie characteristics 
of both a myoma and ovarian tumor, though the symp- 
toms pointed to the former rather than the latter. The 
second one was a distinct subperitoneal myoma, about 
the size of a man's fist, on the anterior wall of the 
uterus. In less than two years the growth bad so 
decreased in size it could hardly be found by the most 
careful examination. 

IFerrum. — Anosmia from loss of blood; stinging 
headache and ringing in the ears before the men 
flow too profuse, passive, and dark, accompanied by 
labor-like pains in the abdomen, and a glowing, red 
face, which is pale at times. 




PLATE IX. 

Ovarian tumor in the left sute of the pelvis. 



TUMORS OF THE GENERATIVE ORGANS. 185 

Platina. — Menses too early and too prof use ; flow 
dark and clotted, with much bearing down and pinching 
pains in the abdomen ; nymphomania ; painful sensitive- 
ness, and constant pressure in the hypogastric region ; 
the body feels cold, excepting the face. 

Sabina. — Menses too early, too profuse, and last 
too long ; hemorrhage from the uterus in paroxysms ; 
worse from motion ; blood dark and clotted, and some- 
times offensive ; with pain from back to pubis. 

II Secede. — This should be freshly prepared, and will 
be found to act best in the tincture or lower dilutions. 
Menses too profuse, and last too long ; uterine hemor- 
rhage, worse from least motion ; discharge thin and 
black ; black, lumpy, or brown fluid, and very fetid ; 
pains in the uterus of an expulsive character. 

\TriUine. — Metrorrhagia, especially at the climac- 
teric ; flow returns every two weeks ; it may be bright 
or dark, oozing away slowly but persistently, and is 
accompanied by pain in the back, and cold limbs. Dr. 
Ludlam speaks highly of this remedy for the hemor- 
rhages resulting from myomas, and thinks it most use- 
ful in those cases where the muscular fibres of the 
uterus have been decidedly developed by pregnancy or 
otherwise. 

Oil of Erigeron, two drops in a dessert- spoonful of 
water every half- hour, is often an efficient remedy for 
bright red, profuse flow of blood, worse on any motion, 
with irritation of the bladder and rectum. 

Ovarian Tumors. 

There is but one way of treating ovarian tumors 
(Plate IX.), and that is by removal. If the operation 



186 TUMORS OF THE GENERATIVE ORGANS. 

is properly performed, the tumor will never return ; if 
left to itself, it will gradually grow till it destroys the life 
of the patient. The average duration of life with an 
ovarian tumor is three years ; if removed, all danger to 
life in consequence of the tumor is likewise removed ; 
the risk of life from the operation is very tittle, Less than 
is common from measles or whooping-cough. Ninety- 
six persons out of a hundred should recover in the hands 
of expert gynecologists, and none bul skilful operators 
should attempt the operation. I have removed them 
successfully at very different periods in life, nor does 
the difficulty of the operation depend on the age of the 
patient : some of my besl cases and Largest tumors have 
been of persons over fifty and sixty year- of age. My 
most serious case was in a young woman of thirty, with 
an immense ovarian tumor on each side, both of which 
were removed at the same time, she finally made a 
good recovery, and went home a well woman four 
weeks after the operation. 

The same treatment i- necessary f or tumor- ^\' the 
Fallopian tubes and broad Ligaments. 

Salpingitis. 

Removal of the Fallopian tubes i> necessary when 
they become distended with matter (pus), forming what 
is known as suppurating salpingitis (Plate X.). It is 
a chronic ahscess which seldom heals, causes almost 
constant confinement in bed, and is liable t<> break into 
the peritoneal cavity and cause certain death. It is a 
disease not generally understood, and is often called 
by mistake pelvic inflammation or cellulitis. Its most 
prominent symptoms are pain in the pelvis, aching, 




PLATE X. 

Salpingitis involving the right Fallopian tube and ovary. 
(Compare Plate I., page 25.) 



TOIORS OF THE GENERATIVE ORGANS. 187 

throbbing, more in the groins than over the bladder. 
The pains are worse from exercise, and aggravated by 
sexual congress. Pain along the spine and headache 
in the back of the head are common. The woman 
may improve for a time and be comfortable, and with- 
out any sufficient reason becomes suddenly ill with 
acute pain in the pelvis. This disease is difficult to 
diagnose without a careful examination by a specialist 
giving ether. A woman will seldom recover from it 
without the right treatment, but her invalidism will 
increase. The most common causes are gonorrhoea, 
and childbed fever. The only remedies which will 
do any good are those recommended for metritis and 
ovaritis, and are to be taken in the same way. 



CHAPTER XVII. 

CANCER OR MALIGNANT DISEASE OF THE 
SEXUAL ORGANS. 

There is probably no disease more dreadful to con- 
template than that now under consideration. The mere 
suggestion of its possibility strike terror to the heart of 
a woman, who will endure anything, pay everything, to 
escape such a fate Unfortunately, there are charlatans 
and quacks everywhere at hand, too often in the guise 
of "doctor," who take advantage of the fact to call 
many things cancer which are perfectly harmless, and 
of com-.' succeed in curing them. t<> the benefit of purse 
and reputation. 

It is a vt'iy common occurrence for women to con- 
sult me. who have heeii seen by Midi unprinci] >led and 
often ignorant individuals, and been told they had a 
"cancer humor/' or a cancel-, when perhaps the 
called cancer was only a wart or equally simple growth, 
while a " cancer humor " does not exist. .Many of t! 
patients have been practically well women, who did not 
need treatment of any kind. Let me warn my reader 
most earnestly against alluring advertisements, free 
consultation, and pay-in-advance "doctors" 

There are several varieties of malignant disease 
known to physicians which need not be mentioned here. 
Such cases must always be under the physician's care. 
It is important, however, to know under what circum- 



COLORED PLATE JR. 




Fid. l . 

Epithelioma or cancer of the cervix uteri at an early stage of development. 
The black ring represents the vagina. (Heitzman.) 




Fid. Z 

o 

Hard cancer of the uterus with commencing ulceration, 
sents the vagina. 'Heitzman.) 



The hlack ring repre- 



CANCER OF THE SEXUAL ORGANS. 189 

stances a physician must be consulted without delay, 
and prompt measures be adopted if anything is to be 
gained by treatment. Nothing is more foolish than to 
delay seeing your physician till it is too late to obtain 
relief, because you fear to know what he will say. 
Nine tenths of the women who think they have cancers 
have none. 

The following rule is of great importance. When- 
ever a woman suffers from a thin, watery leucorrhoea 
(whites), which causes some irritation and smarting, and 
is perhaps a little offensive or a little bloody, she should 
consult a physician and have a thorough examination 
without delay. This is all the more important if she is 
near the change of life, and has had children, or ulcera- 
tion or laceration of the womb. This last is a common 
cause of cancer when not properly treated or operated 
upon. 

This peculiar form of leucorrhoea generally is the 
first indication of cancer of the womb, and after a few 
weeks the patient flows profusely, both at and between 
the monthlies. The discharge is of a brownish red 
color, or like meat juice, and commonly offensive. Pain 
is seldom felt till late in the disease, and a woman may 
feel too well to call in a physician when she is already 
beyond help. The peculiar symptoms mentioned do not 
invariably mean that a cancer is growing, but they are 
of serious importance, and there must be no delay in 
seeing a skilful physician. 

The accompanying colored illustrations show just 
how a cancer of the womb appears through the spec- 
ulum in the commencement of the disease, and are 
carefully painted from nature. The following illustra- 



190 CANCER OF THE SEXUAL ORGANS. 

tion (colored Plate III.) shows how it spreads up in the 
uterus and fills the upper part of the vagina, similar to 
a small head of cauliflower. A patient having this dis- 
ease must never examine herself, as the growth bleeds 
very easily, and she might cause a severe heniorrh; 
The average duration of life with cancel- is eighteen 
months, if nothing is done for it. Treatment often pro- 
longs life, but the question of cure is uncertain and very 
improbable. There is reason to believe, from the best 
of authority and the most careful examination, thai 
cases of cancer in other parts of the body are occasion- 
ally cured, especially by interna] medicine. We should, 
therefore, not abandon the hope thai some day the 
medical profession will treat and cure this dreadful 
disease with mneli more success than at the present 
time. 

It is manifestly out of place to treat of the various 
surgical measures and their respective value in these 
cases. Thai is a matter for the special surgeon to 
determine, and will depend on many circumstances and 
possibilities of the case. 

The odor of the vaginal discharges is sometimes mute 
offensive. A very careful use of four quarts, two or 
three times a day, of one part to a thousand solution of 
thymol for a vaginal douche, is an excellent and per- 
fectly safe disinfectant. A table-spoonful of the aqin sous 
fluid extract of eucalyptus to a quart of water is another 
good disinfectant, which is very healing and soothing 
to parts which are sore. It is a good plan to keep 
ready a saturated solution of alum for a vaginal injec- 
tion, in case of sudden hemorrhage, and it becomes 
necessary to do something before the doctor can arrive. 




PLATE XI. 

Side view of cancer of the uterus at a later period of development. 



CANCEB OF THE SEXUAL ORGANS. 191 

There is one important precaution to observe in using 
the douche. Always use a fountain syringe, and do not 
hang the bag high up. Take off the metal or hard 
rubber nozzle and use the end of the soft rubber tube, 
or else draw a piece of rubber tubing over the nozzle 
and allow the end of the tubing to project two inches 
beyond it. The end should be very gently introduced 
into the vagina, and not be crowded very high up on 
account of the danger of causing hemorrhage. The use 
of opium and morphine should be avoided as long as 
possible. 

Since the patient must be in the care of a physician, 
it would be quite out of place for me to mention the use 
of remedies. 



PART SECOND. 



A Domestic Handbook 



OF 



MIDWIFERY 

WITH SUPPLEMENTARY CHAPTERS. 



DOMESTIC HANDBOOK OF MIDWIFERY. 



CHAPTEE I. 
CONCEPTION. -SIGNS OP PREGNANCY, 

By conception we mean the union of the male and 
female element, the product of which is the com- 
mencement of the life of a new being. Life is always 
present from the beginning, just as there is life in 
a seed, which may be freshly planted, though for a 
time no buds or leaves appear. The question is often 
asked, when is life present ? Life is essential to growth : 
if life be not present, then the product of conception is 
always dead, will cease to grow, and be discharged 
from the uterus. 

The male and female elements have been mentioned. 
Those of the male are known as spermatozoa ; those of 
the female as ova. 

The spermatozoa of the male are contained in the 
fluid (semen, meaning seed) ejaculated in a mass at the 
completion of the act of copulation. The cells (sperma- 
tozoa) are in constant motion, and progress at the rate 
of about three quarters of an inch an hour. Under 
favorable surroundings these cells may live for three 
or four days, or even longer. An acid fluid will 
destroy them, and this is one reason why women 
suffering from an acid leucorrhcea are apt to be sterile. 

When these cells are deposited in the vagina (or 
even at the external orifice) at the completion of the 
sexual act, they ascend into the uterine cavity, enter 
the Fallopian tubes, and there meet the female element, 



196 CONCEPTION. — SIGNS OF PREGNANCY. 

which is absolutely and invariably necessary for concep- 
tion to take place. Quantity or number of either 
element is not to be considered further than that two 
cells, a single cell of each kind, united or fused into one 
is quite sufficient for conception. Conception takes 
place from the moment this fusion occurs, though the 
product of this fusion, the germ of the future human 
being, is less than one hundred and twentieth of an 
inch in diameter, far too minute to be seen by the 
unaided eye. 

The female element, the ovum, is single, unlike the 
thousands of spermatozoa in a single discharge of the 
male fluid (semen), and escapes from the ovary only 
once a month. This process is called ovulation, and 
usually takes place from the ovary on one side one 
month, and from the ovary on the opposite side the next 
month. Some ladies observe the SO] i the men- 

strual periods alternating from one side to the other in 
successive months. Though not positively proven, il is 
generally believed that ovulation takes place at the 
same time as menstruation, and correspondingly an 
ovum is discharged into the Fallopian tube at this time 
ready to be fertilized and impregnated by the male 
element before it is discharged from the uterus, which 
is about fourteen days after it leaves the ovary. 

The ovum is in structure like a hen's egg with- 
out the shell, but it is very minute. Its duration of life 
is about fourteen days, though it may perish at any 
time. It is a matter of common observation that pj 
nancy (/. e., conception") is more frequent in proportion 
to the nearness of copulation to the close of menstrua- 
tion, and that during the period from fourteen days 



CONCEPTION. — SIGNS OF PREGNANCY. 197 

after the menses have ceased to three days before the 
next period, pregnancy rarely follows the sexual act. 
The reason is obvious ; there .is scarcely ever an ovum 
to be fertilized. Self-conception is an utter impossi- 
bility. 

The writer does not wish to be understood that ovu- 
lation takes place only at the time of the menstrual 
flow. It is the rule, however, with a few exceptions, 
such as conception in nursing women in whom the 
menstrual flow has not reappeared, and conception in 
girls who have not menstruated. Ovulation, in excep- 
tional cases, may be delayed till after the monthly flow 
or anticipate them. 

Another essential factor for conception is that the 
elements of the male and female must belong to the 
same species ; for instance, the elements of a sheep 
and dog, a horse and camel, etc., will never unite and 
grow under any circumstances. An apparent exception 
to this rule is the union of elements between a horse and 
a donkey, which leads to the development of a mule. 
The latter animals, however, are, with rare exceptions, 
unable to reproduce their kind. 

The author trusts that his reader's sense of delicacy 
and propriety has not been offended by the above 
remarks. It is necessary to speak plainly to avoid mis- 
apprehension, and he has known of much mental suffer- 
ing and misery in consequence of not understanding 
nature's laws and the growth of our being. 

Menstruation commonly ceases after conception, and 
seldom returns till three or more months after the child 
is born. The recurrence of the periods is delayed by 
nursing, and vice versa. This fact is made use of in 



198 CONCEPTION. — SIGNS OF PREGNANCY. 

fixing the date of delivery, or the birth of the child. The 
duration of pregnancy is two hundred and eighty days. 
In rare cases the period may be prolonged to three hun- 
dred and two days. Beyond this last time the courts of 
most European countries will not allow a claim of 
legitimacy. 

The common rule for estimating the date of delivery 
is to take the firsi day of the last regular and ordinary 
menstruation, count nine months ahead, or three 
months backward, and add seven days. The latter will 
be the probable day on which the child will be born. 
Women pregnant lor the firsl time are often delivered 
a few days before this dab 

It occasionally happens that this rule cannot be used, 
as when conception occurs during nursing an infant and 
before the menses have reappeared, also when the men- 
strual flow has not ceased with the beginning of pn 
nancy. The latter is an exception to the rule, hut in 
these instances the time of delivery can he estimated 
with considerable certainty in the following way ■ No- 
tice when the firsl movements of the child in the womb 
are distinctly felt, and then count twenty-two weeks 
forward from this time. This will be very near the time 
of delivery, too early rather than too late, and should 
correspond with what would ordinarily be the tenth 
menstrual period from the supposed time of conception. 
In a general way an idea of the length of pregnancy 
can be estimated by the size of the uterus pressing on 
the abdomen as follows : — 

End of the Fourth Month. — Very slight protrusion of 
the lower portion of the abdomen corresponding to the 
bladder. 



CONCEPTION. — SIGNS OF PREGNANCY, 199 

End of the Fifth Month. — Top of uterus is half-way 
up to the navel, which is somewhat flattened 

End of the Sixth Month. — Top of the uterus is just 
above the navel, which now protrudes a little. 

End of the Seventh Month. — Top of the uterus is 
half-way between the navel and breastbone. 

End of the Eighth Month. — Top of the uterus is up 
to the breastbone, pressing against the lungs and 
causing some difficulty in breathing. 

End of the Ninth Month. — Top of the uterus sinks 
down and is about at the same height as at the 
end of the seventh month, but there is more pro- 
trusion of the abdomen. Breathing is more free. 
There is increased pressure on the bladder, and com- 
monly considerable mucous discharge from the vagina. 
A day or two before labor the child is often very 
quiet. 

The Signs of Pregnancy. 

The signs of pregnancy are numerous, and nearly aU 
of them are only signs and do not in themselves singly 
afford positive proof of pregnancy. It is rather the 
association of these signs together which indicates with 
almost certainty the true state of affairs. 

The first and most common symptom of conception 
is the cessation of the menses, particularly if this has 
occurred in a woman accustomed to menstruate regu- 
larly and who remains comparatively well. "Wetting 
the feet during the period or other similar causes may 
also produce cessation of the flow ; but under these cir- 
cumstances the health is commonly affected, the patient 
suffers from pain in or about the pelvis, her head 



200 CONCEPTION. — SIGNS OF PREGNANCY. 

aches severely and is apt to throb, nosebleeding is not 
uncommon.' 

If conception occurs just before the period, the flow 
will appear much the same as under ordinary circum- 
stances, but in diminished amount. In a very few 
instances I have known slight flowing to occur for the 
first three or four months of pregnancy, and in one i 
throughout pregnancy ; but such instances only form 
rare exceptions to the rule. 

Increased frequency of passing water and of leucor- 
rhoeal discharges are not uncommon anion-- the early 
symptoms. Morning nausea and sickness at the 
stomach may lie an early sign of pregnancy, but it 
occurs most frequently from the end of the second 
month to the middle of the fifth month, after which it 
usually ceas< 

The breasts begin to swell in the third month, and 
soon after a drop or two of watery fluid can be squeezed 
from the nipple. In women pregnant for the first time 
this is an important sign of pregnancy. Milk in the 
breasts in small quantities has been known to occur 
from the presence of ovarian tumors, and instances are 
recorded where the male member of the family has 
nursed the infant, and also where the child has drawn 
its nourishment from some female member of the family 
who was not and had not been pregnant for sonic years. 
While these last instances are enough to prove that 
milk in the breasts is not an absolutely certain sign of 
pregnancy, the exceptions are so rare that it constitutes 
a valuable sign taken in connection with the other 
symptoms mentioned. 

About the fifth month of pregnancy signs of much 



CONCEPTION. — SIGNS OF PREGNANCY. 201 

importance appear, especially in brunettes, in whom 
these signs are more marked than in blondes. The skin 
around the nipple becomes very much darker from a 
deposit of pigment, and the hair follicles stand out like 
the fine pimples of goose flesh. ' Around the dark circle 
of skin are seen little spots like drops of water dried on 
the skin and water- marking it. 

At about four months, i. e., from the sixteenth to 
the eighteenth week, the movements of the child are 
first felt. In exceptional cases I have reason to believe 
motion was felt as early as the twelfth week of preg- 
nancy. At first these movements are like wind moving 
in the bowels, and have also been very aptly compared 
to the quiver of a frightened bird in the hand. The 
important point to remember is the persistency and 
gradually greater distinctness of the sensation if it is 
motion of the child. 

From this time there can be little doubt of the posi- 
tive existence of pregnancy. The physician can now 
hear the sounds of the fetal heart with the stethoscope, 
which is positive evidence of pregnancy. If a child be 
born before the seventh month of pregnancy, it will 
almost surely die ; after the seventh month it is the 
more likely to live the nearer it is to the full period of 
pregnancy. The common impression that a premature 
child born at seven months is more likely to live than 
one at eight months is wholly false. 

In the latter part of the ninth month of pregnancy, 
the exact position of the child can be readily felt 
through the abdominal wall, and most physicians trained 
in the modern methods of obstetrics are in the habit 
of making a careful examination of the case. If the 



202 CONCEPTION. — SIGNS OF PREGNANCY. 

child occupies a bad position, as a cross-birth, it almost 
always can be turned by external manipulations into 
a simple position for labor and kept there by a binder. 
The physician, being fully aware of the nature of the 
case and the difficulties, if any, likely to be encountered, 
can be prepared much better to care for his patient and 
to avoid danger than if the examination be not made. 
The term -false conception" is often used in refer- 
ence to cases of pregnancy in which the embryo dies 
and is finally expelled from the uterus either in a with- 
ered form or bavin-- the appearance of dark red, 
crumbly flesh, or in bunches of vesicles or bladdi 
similar in arrangement to a bunch of grap 



CHAPTER II. 
HYGIENE OF PREGNANCY. 

Pregnancy at best is accompanied with much dis- 
comfort, and sometimes with real suffering. Much 
relief can be obtained by following the directions given 
in this chapter, and both mother and child will be the 
better for observing them. 

Perhaps there is no disturbance of the system more 
common than that of nausea and vomiting. The treat- 
ment of this disorder of the stomach will be considered 
in the chapter on the " Diseases of Pregnancy." The 
symptoms or sensations experienced are very similar to 
those of the various forms of dyspepsia, and, like the 
latter-, can be very much alleviated by a diet suitable to 
ordinary disorders of the stomach. A proper diet also 
will be useful to maintain good health of the mother 
and to promote the development of vigorous, healthy 
offspring. 

It* is not uncommon to find persons who are unable 
to digest common articles of food. I have one patient 
with whom oranges always disagree, and another one 
who can eat the indigestible banana after severe sick 
headaches and vomiting, when nothing else is tolerated 
by the stomach. Other people cannot eat eggs, etc., 
and so the list might easily be made a long one. The 
fact to remember is that in giving rules for all persons 
to follow, only rules for the great majority can be 
given. Each woman is a law to herself, and individual 



204 HYGIENE OF PREGNANCY. 

idiosyncrasies must form exceptions to the rules. No 
one is to eat an article of food recommended, when they 
know by ample experience that it will disagree, or i 
versa. 

The following articles, with exceedingly rare excep- 
tions, the pregnant woman must never eat : fat food. 
anything fried, melted butter, hot buttered toast, highly 
seasoned food, as mince pie. rich pie-crust, pastry, much 
pepper or salt, strong tea or coffee, chocolate, much 
sugar or confectionery, hot biscuit or fresh bread, rich 
preserves or cake, pork, veal, stews, hashes, gravies, 
made dishes, rich desserts, cheese, radishes, horse-radish, 
raw cabbage, and clam-. Brown bread and beans, and 
Indian meal in any form, unless thoroughly well cooked, 
are Less important, but ought to be discarded. The li-t 
may seem a Long one. but 1 wish to state emphatically 
that not an article is mentioned but that will pi 
harmful to nearly every pregnant woman. The tact 
that the stomach is causing no trouble, i- no excuse 
for eating them. The pi-oneness of the stomach to 
disorder makes it all the more important to keep it 
as healthy as possible, and neither to irritate nor to over- 
load it. 

A selection o\' food can be made from the following 
list, which usually proves digestible, and will provide a 
good quality of nourishment for both mother and child : 
mutton, chicken, or oyster broth ; raw oysters, white- 
fish if it usually agrees ; beef, mutton, fowl, gam. 
a verv moderate amount of fresh butter, never mixed 
or eaten on hot food or melted ; sweetbreads. S. one- 
times a bit of well-toasted salt codfish or a very 
thin slice of bacon broiled quite brown will help the 



HYGIENE OF PREGNANCY. 205 

patient to relish the other articles of food. Ham can be 
eaten, but is liable to disagree ; fried eggs are also likely 
to prove indigestible, on account of the fat. Some pa- 
tients like sweetbread (pancreas of a calf) which makes 
a change from the ordinary fare. Good wheat bread, 
never fresh nor hot, oat meal, wheat germ, corn meal, 
which must not be eaten unless thoroughly scalded and 
cooked a long time, rice, and Irish or sea moss as used for 
blanc- mange, form less important articles of diet. Dry, 
mealy baked potatoes (sweet potatoes are usually too 
hard to digest), spinach, macaroni, greens, cresses, green 
peas, lettuce, asparagus, oranges, grapes, stewed fruit 
(but not preserves), ripe peaches, baked apples, and ripe 
berries in their season. If there is any tendency to 
diarrhoea, fruit must not be eaten. If the contrary, 
and the common condition of constipation be present, 
eating freely of ripe fruit will tend to relieve it. 

A hearty meat and vegetable diet is necessary for 
mother and child. The mother must be kept as healthy 
as possible, as she has to meet not only the demands of 
her own system for nourishment, but also those of the 
developing fetus. It must follow that any lack of 
nutrition is at the expense of one if not both indi- 
viduals, and may cause serious injury. There is no 
theory more fallacious than that if a strictly vegetable 
diet be observed, the child's bones will be softer, labor 
easy, with no harm to either parent or infant. There 
is reason to believe that the child may take the necessary 
lime salts for its bony growth from the mother's system, 
if it is not provided in the food, so that diet does not in 
itself prevent the growth of bone substance. Further- 
more, such a vegetable diet tends to the development of 



20G HYGIENE OF PREGNANCY. 

rachitis in the infant, a serious disease which often ends 
in permanent deformity. 

The maternal hlood at the end of pregnancy, even in 
the best of circumstances, tends to become watery and 
needs a good healthy supply of nutriment from meat 
food. The better a woman's general health, the more 
likely is she to experience a normal labor and quick 
recovery. We may do many things in the hope of an 
easy confinement, but easy confinements are so common 
and differ so much in the same women, that we can 
never say how the labor would have been if the 
measures adopted had not been tried. 

The teeth very commonly decay during pregnancy ; 

whether this be due to absorption of lime salts from the 

maternal organism, or is in consequence of the acid 
dyspepsia so common in pregnancy, <>r again, as my 
friend, Prof. Miller, of Berlin, would say. t<> the growth 
of bacteria, I am unable to determine. The fact is well 
known, however, and pregnancy should not interfere 
with filling them. If the cavities are Bore and painful, 
temporary fillings of gutta-percha will answer. It .'> 
better not to occupy the dental chair a Ion- time, and 
fatigue must be avoided; it is also advisable not to have 
the teeth filled near what would be ordinarily ;i monthly 
period. 

Much has been said regarding very extraordinary 
longings of women during pregnancy. 1 have not seen 
any such case which would be any different from 
what might occur in various circumstances quite inde- 
pendent -of pregnancy. Should my reader happen to be 
such an unusual case, then I would advise her to follow 
the rule of eating only what is positively known to 



HYGIENE OF PREGNANCY. 207 

agree with her, and to follow the list just mentioned, 
rather than to gratify a fancy, expecting her system 
needs it and that it will do her good. 

The dress should he free and easy, supported from 
the shoulders, and not restricting the motion of the body 
in any way. When the protrusion of the abdomen 
carries the dress away from the lower limbs, a flannel 
skirt or drawers must be worn for protection from 
draughts of air ; garters wound round the limbs must be 
discarded also, as they obstruct free circulation and tend 
to cause varicose veins : ordinary corsets should never 
be worn after four months and a half, and the habitual 
wearing of tight corsets or of very close-fitting dresses 
often presses in the nipples, which may render it impos- 
sible for a child to nurse. Short riding corsets or waists 
made for the purpose are often worn with comfort and 
do no harm. 

During the last four months of pregnancy particular 
attention should be given to the breasts to prevent sore 
nipples and the formation of an abscess — known as 
"broken breast " or " gathered breast- 1 — and to have 
the nipples drawn out so the child can easily nurse. This 
last is best done by drawing the nipples well out be- 
tween the thumb and finger and keeping them stretched 
out for a couple of minutes at a time whenever the 
breasts are bathed and rubbed. Sometimes drawing 
out the nipple and tying a piece of worsted around it, 
just snug enough to keep the nipple out without 
obstructing circulation, is a good thing. Actual pain or 
the production of soreness must be avoided. Just before 
nursing the nipples can be drawn out by an ordinary 
new clay pipe, or by pouring hot water into a large 



208 HYGIENE OF PREGNANCY. 

bottle, emptying it, and applying the mouth of the bottle 
over the nipple ; as the glass cools, the nipple is gently 
drawn out. The best method of toughening the breasts 
is to begin at the sixth month to bathe the breasts at 
night in a warm room with cool salt water (00° P.), and 
rub the breast gently, especially around the nipple, with 
the palm of the hand. This friction produces a thick- 
ening of the skin, on the same principle that work causes 
a toughening of the skin in the palm of the hand. The 
rubbing of the breast is essential on this account, but it 
must never be vigorous enough to cause any sorem 
Tannin and glycerine strong enough to taste quite 
puckery, also boras and alcohol, are good applications to 
be used in the same manner. (See pag 

The skin of the abdomen is of ten tender from over- 
stretching^ this is relieved in a measure by gently rub- 
bin-- olive oil freely all over the abdomen. 

Miscarriage is mosl likely to occur at what would 
be ordinarily the menstrual periods. For this reason, 
extra care and an extra amount of rest should be taken 
at these times, particularly the second, third, sixth, and 
seventh months of pregnancy. Women who have pre- 
viously miscarried ought to remain in bed for three or 
four days at each menstrual epoch. Excepting at the 
time just mentioned, exercise in the open air is advis- 
able throughout gestation, as it is essential to good 
health. A walk should be taken every pleasant day. 
always stopping before it causes fatigue. Even in the 
last month or two the figure can he concealed by a 
Mother Hubbard style dress, a circular, or a short sack 
loose in front. Under all circumstances carefully avoid 
lifting, reaching, dancing, moving furniture, pushing 



HYGIENE OF PREGNANCY. 209 

up windows or screens, working bent over in a cramped 
position ; the wash-tub is responsible for many a mis- 
carriage, riding over rough roads or horseback, and 
also long railway journeys. 

Bathing is important to promote the action of the 
skin, and to relieve the kidneys as much as possible from 
the increased work put on them in consequence of preg- 
nancy. A sponge bath with warm salt and water, fol- 
lowed by vigorous friction in a warm room, should be 
taken at least once, and better, three times a week. 
Turkish baths, very hot sitz, or full baths over 105° F. 
must not be used. The increased amount of vaginal 
secretion often makes it necessary both for cleanliness 
and comfort to use once a day a vaginal douche of a 
pint of lukewarm castile soap and water, taking pains 
to separate and cleanse the lips of the vulva, especially 
when there is much itching of the parts. 

So far as possible, husband and wife should occupy 
separate rooms, or at least different beds. Marital rela- 
tions should be as infrequent as possible, and ought not 
to be indulged in either during pregnancy or for six 
months afterward, and never at what would ordinarily 
be the time for the monthly flow. 

The production of sex at will would be extremely 
desirable were it possible. Many theories have been 
advanced, and many women believe they can tell by 
their sensations the sex of the unborn child. Con- 
siderable success has attended efforts at producing the 
desired sex in raising cattle, by simply observing the pas- 
sions of the animals, the sex produced being the opposite 
to the most passionate animal. Taking the experiments 
on the lower animals as a basis, Dr. M. 0. Terry has 



210 HYGIENE OF PREGNANCY. 

written a small book in which he advocates the proba- 
bility of producing the desired sex in the human animal. 
It is obvious that any experiments in this direction or 
the necessary information, to act on any scientific ba 
would be extremely difficult to obtain from either men 
or women, particularly the Latter. So far as niy obser- 
vation goes in perfectly authentic cases, girls have been 
born when conception took place Boon after menstrua- 
tion, and boys have been born when conception must 
have occurred ten or more days after the cessation of 
the monthly discharge. 1 would not, however, make 
this any ride, but only state that I have observed this 
in some cases when the facts were known. There i 
yet no certain way of having offspring of the desired sex. 

Birthmarks, i. >.. some mark on the child or de- 
formity as the result ni something seen by the mother 
oi- shocking her. are dreaded by many mothers. It is 
very common to hear women relate how it happened 
that their children were "marked." It would he an idle 
waste of time to discuss the question with persons entirely 
unacquainted with embryology and its allied branches. 

It is true that fright, apart from mechanical cai 
may produce miscarriage, bul this is because uterine 
contractions are excited through the nervous system, 
and the child is forced out of the uterus, not that the 
child itself is affected ; or the contracting uterus ma 
interfere with the circulation in the afterbirth (placental 
as to suffocate the child, and not expel it tor ><>me 
weeks after the fright. 

Family characteristics are transmitted to children 
through the ovum of the mother, or the spermatozoa of 
the father, for the child is a union of actual {tortious of 



HYGIENE OF PREGNANCY. 211 

both parents, a part, as it were, of* their bodies, and as 
in plant and animal life, it would be very strange if the 
child did not possess traits characteristic of its ante- 
cedents. There is, however, no direct communication 
between the mother and her offspring in utero, neither 
by blood, nerve, nor muscle, and changes of tempera- 
ture affecting development can hardly be conceived. 

How often a mother feels sure her baby will be 
marked, and it is not ! How seldom, if ever, do we hear 
of joy affecting the marking of a child, and how often it 
is attributed to sorrow or fright ! Yet if mental emo- 
tion of one kind will have any effect, certainly the 
opposite emotion should show some influence. Perhaps 
no mothers passe'd through more trying times, or saw 
more awful sights, than during our late Civil War, yet 
there are no observations showing any increase in birth- 
marks or deformed children during that period. It is 
true that, in times of extreme famine, an increase of 
such children has been noted, but this is due to an 
entirely different cause, that of nutrition. 

It is said that King James could not bear the sight of 
a drawn sword, and good-meaning women at once con- 
cluded it was because his mother, Mary Queen of Scots, 
had seen Eizzio cut down in her presence ; but we are all 
familiar with the peculiarities and eccentricities of people 
not attributable to prenatal influence. 

While I believe we have no positive evidence of 
maternal impressions disfiguring a child, and consider it 
an extreme improbability, the possibility of it cannot 
be positively denied, as it is not possible to deal with 
simple facts from which all possible causes have been 
eliminated. 



212 HYGIENE OF PREGNANCY. 

The Greeks were firm believers in prenatal influence. 
The pregnant woman was surrounded with works of 
art and beauty, and everything, so far as possible, was 
made to contribute to her enjoyment and comfort, in 
order that the child should be born with corresponding 
tastes and fine proportions. It is doubtful if these 
Greeks ever have been surpassed in perfeel develop- 
ment and knowledge of fine proportions of the human 
form, as seen by the h'w remaining specimens of their 
art. It is more than likely, however, that this same 
development of mind and form could have heen due to 
the cultivation of athletics, letters, and to the peculiar 
Bystem of laws which had for an object the stamping 

out and elimination from their race of deformed or 

puny infants. 

In concluding this chapter, I wish to draw attention 
to the increase of irritability and nervousness during 
pregnancy. It should always be remembered that this 
peculiar and unusual state is due to the condition of the 
woman. At such times she should be dealt with vnv 
kindly and tenderly, remembering the fault is a phys- 
ical and not a moral one. She needs kindness and 
sympathy for all her every-day trials, doubts, and fears, 
and for those in store for her. Friends who give it 
freely with frank encouragement, never casting doubts 
or suggesting anything to fear, are friends in truth and 
deed. 



CHAPTER III. 

DISEASES OP PREGNANCY. 

This chapter does not pretend to give directions for 
all the ailments of pregnancy, but only for those which 
can be treated safely by domestic measures. Should 
these fail and the complaint become severe, summon a 
physician without further delay. 

Perhaps the most troublesome and common com- 
plaint is that of nausea, often attended by vomiting or 
constant spitting of cottony saliva from the mouth. 
The nausea commonly is worse in the morning, and for 
this reason is called morning sickness. Complete cure 
of it is exceptional, as the cause of the disorder — expan- 
sion of the uterus — cannot be removed without indu- 
cing miscarriage, and in severe and aggravated cases 
this is by no means a radical cure. The disorder of 
the stomach may be a mere sensation of nausea in the 
morning, or become so severe as to cause frequent vomit- 
ing of a little glairy mucus or fluid, not allowing any- 
thing to remain in the stomach, and actually causing 
starvation. The treatment must be largely dietetic : if 
even a little food can be retained and the walls of the 
stomach nourished, something has been accomplished 
and improvement will follow. 

In mild cases the taking of a little hot milk or broth 
on first waking in the morning and before even raising 
the head from the pillow often will give relief if the 
patient remains in bed twenty minutes after taking the 



214 DISEASES OF PREGXAN'CY. 

food. Wherever nausea and vomiting exist to any 
extent, it is always advisable to go to bed and keep as 
quiet there as possible, with plenty of cool (not cold) air 
in the room. Eat very little, only sips at a time, but 
often as the stomach can bear it : the food should be 
concentrated and easily digested. The following list 
comprises many articles most likely to agree, but all 
may tail and something else must be found ; the impor- 
tant point to remember is, perfect rest, and food in sips 
or teaspoonful <lo><>> as often as the patient can bear it : 
milk iced or hot, diluted or tall strength, as the patient 
can take it ; chicken broth ; clam water, but net the 
clam; peptonized milk or gruel; toasted bread or 
cracker; peptonized boot (Reed A: Carnick's beef pepto- 
noids in powder) ; beet juice, squeezed from rare cooked 
steak, or Wyeth's beet juice ; malted milk ; wine whey ; 
buttermilk ; mutton broth; and white of egg and Water 
beaten together, are all good. Koumis 1 tastes similar 
to buttermilk charged with carbonic acid gas, and is 
relished by some ladies ; a moderate amount of spring 
water in small quantities at short intervals is allowable ; 
a siphon of soda water or Apollinaris water to quench 
thirst is sometimes more effective than ordinary spring 
water. Some patients feel the need of a mild stimulant 
at times of sinking and depression ; then champagne, 
or, if that tastes too sweet, a little bock wine answers 



1 An excellent rceipe for koumia is as follows: live quarts oi 
milk, two and one hall' pints hot water, three fourths of a teacup of 
Bugar dissolved in hot water: mix and add one halt cup liquid bakers 1 
yeast (brewers' might he better). Let it stand in a warm place till it 
bubbles, then strain and cork tight in strong beer hottles. Keep it cool ; 
open carefully without shaking. It can he used thirty-six hours after 
making, and has more u pop" if it stands longer. 



DISEASES OF PREGNANCY. 215 

the purpose. It is not necessary for a patient to eat 
much : a pint of milk or its equivalent in twenty- four 
hours is quite enough to sustain a woman for a con- 
siderable time, when the stomach will improve and more 
food be retained and digested. If the stomach becomes 
so irritable nothing can be retained, either food or drink, 
or if the amount of food taken be insufficient, nutritive 
enemas must be given. Four ounces for one injection 
into the rectum, not oftener than once in three hours, is 
the rule. If an injection is expelled soon after it is 
given, do not give another at once, but wait an hour for 
the irritation to cease before giving the next one. 

Peptonized milk is an excellent injection. I have 
used for an enema with much satisfaction one egg. a 
tablespoonful of beef peptonoids iReed <k Carnick's 
powder ), and enough milk to make three or four ounces ; 
sometimes the capacity of the rectum is small, and a 
four-ounce enema excites contraction and is soon 
expelled when a three-ounce enema might be retained. 
One more practical point in giving an enema for nutri- 
tive purposes : use an old-fashioned hard rubber four- 
ounce piston syringe ; inject very slowly, taking ten 
mmutes to give the enema at blood heat (98.4 G F. • ; 
after the injection has been given, press a folded napkin 
gently but firmly against the anus for another ten 
minutes. These precautions will enable a woman to 
retain an enema which otherwise might be expelled. 

If the thirst is extreme and the patient cannot toler- 
ate water in the stomach, give an injection of clear 
water night and morning. 

This plan of treatment is often sufficient to relieve 
the patient, if not to cure her. till the fifth month is 



216 DISEASES OF PREGNANCY. 

passed, and then the symptoms commonly abate. In 
all severe cases a physician must be consulted, who will 
make a careful examination of the uterus, and often 
pursue a plan of treatment which would be impossible 
for a woman to employ herself. 

Medicines are often of great value in relieving the 
patient. Prompt and permanent cures are exceptional, 
as the cause cannot be removed. Any of the remedies 
mentioned are to be taken in the third decimal potency. 
a dose once in two hours till better, then once in four 
hours till decidedly relieved, and then only once a day 
till cured. Bathing the spine two or three times a day 
with hot salt and water has <»t'ten a very soothing 
effect. 

Therapeutics. 

Arsenicum. — Vomiting after eating or drinking 
with attacks of faintness ; greal weakness and emacia- 
tion : exhausting diarrhoea ; a drink of cold water is felt 
<tll the way down and in flic stomach; extreme thirst; 
burning pain in the stomach and how.!- ; generally 
better from moving about. When Arsenicum fails to 

relieve these symptoms, give Phosphorus. 

Ipecac. — Continual nausea, not a moment's relief, 
also vomiting and diarrhoea ; hitter, yellowish fluid 
vomited up ; vomiting with colic and diarrhoea. 

\Nux vomica. — Nausea and vomiting, chiefly in 
the morning ; thinks she would feel better it she could 
vomit ; sour, acid vomit, setting the teeth on :on- 

stipation ; weight in the stomach : irritability of temper ; 
hitter or sour taste, belching, eructations, hiccoughing, 
and heartburn. 



DISEASES OF PREGNANCY. 217 

II Oxalate of cerium 1 *. — Take what will lie heaped 
up on a penny. This is often a very efficient remedy 
for persistent nausea and vomiting. 

Symphioearpus racemosa was the favorite prescrip- 
tion of a well-known professor of obstetrics in New 
York City. 

I Ye rat rum album has proved successful for violent 
and profuse bilious vomiting, with thirst, cold sweat 
on forehead, cold feet and hands ; extreme prostration; 
also, if with these symptoms there should be a watery 
diarrhoea ; desire for fruit and juicy things, for acids 
and salt food, for cold food ; very hungry ; feels very 
weak and faint. 

Salivation, i. e., a very profuse flow of saliva, is 
sometimes quite a distressing condition : a dose of Mer- 
cur i us viv. once in three hours will relieve some cases, 
and Pulsatilla taken in the same way is good to check 
the constant spitting of cotton-like mucus. I regret to 
add, however, that remedies do not, as a rule, cure 
salivation, but may give relief and will do no harm. If 
these fail, try Iodine; and if then unsuccessful, Jabo- 
randi. Use them in the third attenuation, once in 
three hours. 

Toothache is sometimes a distressing complication of 
pregnancy. Pulling the tooth is not hkely to afford 
relief ; any cavity should be filled; if it is tender or sore, 
I would recommend a temporary filling of gutta-percha. 

If the teeth decay rapidly, take special pains to brush 
the teeth twice daily, and afterward rub freely on the 
teeth and along the gums finely pulverized English 
chalk. If the mouth is acid (this can be easily told by 
putting a bit of blue litmus paper in the mouth, a red- 



218 DISEASES OF PREGNANCY. 

dish color will be seen on it if acid is present), rinse the 
mouth thoroughly twice a day with this alkaline mouth- 
wash : — 

H; Sodii bicarb. 3-is<; ». Ag. deatil § .ittss. 
to neutralize the acidity which hastens decay of tin- 
teeth. The following tooth powder, used oner or twice 
a week, has a similar effect : — 

ft Cretse alb. § t< ftfagnes. curb.. Sodii bicarb. " ■/ gr. xvf. m. 

Big. Alkaline tooth powder. 

Therapeutics. 

Remedies occasionally relieve. Take a dose once in 
half an hour, one two, or three hours apart, according 
to the severity <>i the pain. Use the third decimal 
potency of the medicines mentioned. 

Calcined flourica. — Toothache in hollow teeth, 
around loose stumps, with sore, easily bleeding, painful 
puns; pain worse from cold drink, any change of tem- 
perature of air or food ; offensive odor from the teeth ; 
also if the toothache is associated with severe bursting 
headache in persons having much dandruff ^u the scalp : 
headache worse from motion, taking cold ; better from 
tight bandaging, and lying down with the eyes shut. 

Kreosote. — Drawing pain toward the temples from 
decayed teeth ; pain not very sharp : much nausea and 
vomiting of sweetish water. 

Magnesium phos. — Severe toothache in lightning- 
like flashes of pain, shooting or boring : changing 
locality readily, and relieved by warmth and pressure. 

Mercurius protoiodide. — Teeth very sore, feel too 
long and loose ; pain worse at night in bed ; pain through 
the whole side of the face from a single decayed tooth : 
face red, swollen, very sensitive to draughts of air : rest- 



DISEASES OF PREGNANCY. 219 

lessness, sleeplessness, tears stand in eyes ; also if there 
is much saliva in the mouth. I have often seen the 
great value of this remedy for toothache with decayed, 
sore teeth. 

Sepia. — One of the best remedies for the toothache 
of pregnancy : beating, stitching pain ; pain extending 
to the ears or even the arms, leaving a numb, creeping 
sensation there ; severe congestive headaches ; also if the 
headache alternates with the face ache ; moth patches 
on forehead or bridge of the nose ; distressing, gone, 
empty sensation in the stomach. 

Plant ago. — Shooting, tearing neuralgic pain in the 
left jaw extending to the ear ; toothache, soreness of 
the sound teeth while eating, and rapid decay of the 
teeth. 

Compare toothache with menstruation, page 61, 
Part I. 

Heartburn is another complaint more common in 
the latter months of pregnancy. I have found that 
Pulsatilla in the third decimal dilution, a dose once in 
three hours, will often remove the complaint. If this 
fails, I give Capsicum, third dilution, in the same way. 
If with the heartburn there is much acidity of the 
stomach, give Calcarea carb., third decimal trituration, 
once in four hours, and eat grapes or fruit which have 
only a little sour flavor. 

Constipation is to be treated the same as in ordinary 
circumstances. I will only remark here that Collinson ia 
2x dilution before meals and on going to bed is an excel- 
lent remedy for constipation during pregnancy, or just 
after delivery, and for the piles which often accom 
panies this condition of the bowels. 



220 DISEASES OF PREGNANCY. 

Frequent passing of water is so commonly dependent 
on the mechanical pressure of the growing uterus on 
the bladder, as well as irritation of the bladder from the 
same cause, that I do not consider medicines of much 
use in treating it. There are some exceptions to the 
rule, and these had best be treated by the family 
physician. 

For the treatment of leucorrhoea or itching of the 
parts, the reader ie referred to the chapter on "Pruri- 
tus Yulv;r." page T3, Part I. 

It is not uncommon for pregnancy to terminate at 
any time before the completion of full time, i. e., nine 
calendar months. It most often occurs al what would 
be the time for a monthly period, especially at the 
second, third, fourth, and sixth months. This termina- 
tion of pregnancy has received the names of abortion, 
miscarriage, and premature Labor. Physicians make uo 
distinction in the terms "abortion" and "miscarriag 
and both mean the termination of pregnancy, either 
from criminal or natural causes, before the end of the 
twenty-eighth week or seventh month, while the child 
is not viable, i. e., incapable of living outside the uterus. 
Premature Labor means the premature interruption 
of pregnancy after the twenty-eighth week (seventh 
month), when the chances for the living of the child 
increase in proportion to its maturity, i. e., approach 
to full nine months of pregnancy. 

People in general make a distinction and use the 
word "abortion" to mean the criminal interruption of 
pregnancy, and " miscarriage " to refer to it when pro- 
duced by accidental and natural causes. 

It is with much regret that duty compels me to 



DISEASES OF PREGNANCY. 221 

dwell on the unpleasant and repulsive, yes. horrible 
subject of criminal abortion, and by this I mean the use 
of any means to destroy the life of the child. It is not 
only murder, but the destroyer is the parent who ought 
to welcome and protect the helpless babe. "We have 
already seen that life is always present from the 
moment of conception, so long as growth continues, and 
the taking of human life means a stained, scarred con- 
science, a crime against one's self, society, and the 
State. 

Every woman and every man is well aware of the 
consequences liable to follow sexual intercourse and 
the indulgence of mere animal passions, and those who 
are so gross and sensual in nature always ought to be 
ready to assume all responsibility. It is to be hoped 
that no one will have sunk so low as to plead pleasure 
and passion for excuse : it betrays too gross a nature, 
too low a plane of life. 

The readiness with which respectable women will 
apply to respectable physicians to relieve them from 
maternity has made me think they did not know the 
personal risk to their own lives, or the criminal charac- 
ter of the procedure ; for this reason I quote below the 
text of the law of this State, which is essentially the 
same throughout our country : — 

Chapter 207. Section 9. Public Statutes of Massachusetts. 

Whoever, with intent to procure miscarriage of a woman, unlaw- 
fully administers to her. or advises, or prescribes for her. or causes to 
be taken by her. any poison, drug, medicine, or other noxious thing, or 
unlawfully uses any instrument or other means whatever with the like 
intent, or with like intent aids or assists therein, shall, if the woman 
dies in consequence thereof, be imprisoned in the State prison not 
exceeding twenty nor less than five years, and. if the woman does not 



222 DISEASES OF PREGNANCY. 

die in consequence thereof, shall be punished by imprisonment in the 
State prison not exceeding seven years nor less than one year, and by a 
line not exceeding two thousand dollars. 

Section* 10. Whoever knowingly advertises, prints, publishes, dis- 
tributes, or circulates, or knowingly causes to be advertised, printed, 
published, distributed, <>r circulated, any pamphlet, printed paper, book. 
newspaper, notice, advertisement, or reference containing words or 
Language giving or conveying any notice, hint, <»r reference to any 
person or to the name of any person, real or fictitious, from whom, or 
to any place, house, -hop. or oilier where any poison, drug, mixture, 
preparation, medicine, or noxious thing, <>r any instrument or mean- 
whatever, or any advice, direct ion. Information, or knowledge may be 
obtained Cor the purpose of causing <>r procuring the miscarriage of a 
woman pregnant with child, shall be punished by Imprisonment Id tin- 
state prison or jail not exceeding three year-, or by a fine ool exceeding 
one thousand dollar-. 

Yet ill the face of all this, a woman will seek a 
physician for relief, when in addition to the above risk, 
apart from the obligations of moral law. she knows 
there is always a serious danger to life, almost always 
the impairment of health, and an open gate to chronic 
invalidism in consequence. 

Perhaps my reader may ask what shall be done with 
an unfortunate girl with the prospects of a mined life 
before her? Marriage is the most honorable course; 
otherwise send her away "on a visit." But let that be 
to a quiet, respectable place, where she will be unknown. 
and where she can be confined either there or in some 
thoroughly reputable lying-in hospital, [f the young 
mother then feels herself positively unable to care for 
the infant personally, let it be adopted or well cared for 
by. some kind, motherly woman who can give it every 
attention ; but never allow the helpless child to pass 
into the hands of those women who make a bush 
of "boarding" such children, vulgarly known as "baby 



DISEASES OF PREGNANCY. 223 

farmers "; very few babies, as a rule, survive more than 
a few months at such establishments. 

Miscarriage is not uncommon from purely natural 
causes, such as a severe fall, a blow in the region of 
the pelvis, abuse of the marital relations, overwork, 
lifting, reaching, moving heavy furniture, going up 
and down stairs a good deal, smelling the fumes from 
fresh paint, diarrhoea, long rides by train or over rough 
roads. All such causes should be very carefully avoided. 
There are. of course, other causes of miscarriage, such as 
disease transmitted to the child from a parent, especially 
syphilis, misplacements and disease of the uterus, 
which are necessary for the family physician to treat. 
Indeed, the doctor must be invariably summoned when 
such a misfortune as a miscarriage is threatened or tak- 
ing place. These cases are almost invariably more 
trying to the physician and more injurious to the 
patient than labor at full term, as the uterus is not in 
a condition to undergo, the physiological changes which 
take place in mature pregnancy. I wish every woman 
at such a time could be impressed with the necessity of 
giving herself sufficient care. It would save her much 
subsequent suffering, and many a doctor's bill. 

There are. however, many things which should be 
known and can be practised in a domestic way with 
benefit. 

The symptoms which point to miscarriage are : 
pain in the pelvis of a pressing or bearing-down charac- 
ter ; a pinkish or bloody discharge from the vagina, or 
a gush of watery fluid from the same place, and a sensa- 
tion of coldness over the bladder. If there is but very 
little discharge of blood and scarcely any pain, it is 



22-i DISEASES OF PREGNANCY. 

probable that miscarriage can be avoided ; but if there 
is free flowing and sharp pains, there is scarcely any 
hope of preventing it, and miscarriage is then inev- 
itable. 

Under all circumstances the patient must go to bed 
at once and remain there perfectly quiet ; send for the 
physician immediately, telling him what is the matter ; 
have plenty of cool air in the room ; remove all the 
pillows from under the head and shoulders : neither eat 
nor drink anything hot or any spirituous liquor : requesl 
every one to Leave the room except the one or two per- 
sons absolutely necessary to remain there; the gossip 
of neighbors, the anxiety of friends, the well-meant 
prescriptions of all together are vexatious to the patient 
and do more harm than good, one thin-- in particular 
must he remembered as of great importance: prea 
every clot of blood and every bloody piece of cloth or 
stained clothing for the critical inspection of the physi- 
cian, lor by them he will judge what has taken place, 
and what has come away from the uterus. It is very 
important for the cavity of the uterus to he completely 
emptied, as flowing will surely take place at irregular 
intervals, and septicaemia or blood poisoning is liable to 
develop. Indeed, it is a practical point to remember 
that if, after a miscarriage, a woman is subject to irregu- 
lar, continuous, or sudden attacks of hemorrhage from 
the vagina, there is very little doubt but that the uterus 
contains something which does not belong there, prob- 
ably a piece of placenta, which must he removed with- 
out delay. 

Rest is the essential point in the management of 
these cases. No matter how well a woman may I 



DISEASES OF. PREGNANCY. 225 

she should never sit up till after the tenth day or 
resume her household duties in less than three weeks. 

Therapeutics. 

Give a dose of the third decimal preparation once in 
three hours. 

Arnica is an excellent remedy for threatened mis- 
carriage from an injury, with a sore, bruised sensation 
within the pelvis. 

Secede Cornutum is another reliable remedy for 
threatened miscarriage with pinching, bearing-down 
pains and scanty hemorrhage. 

Sabina, Belladonna, and Ipecac are excellent if the 
flowing is the prominent symptom. The indications 
for these remedies will be found on page 107, Part I. 

Organic diseases of the heart, especially those of the 
mitral valves, are dangerous complications of preg- 
nancy, and such cases should always be under the care 
of a very skilful physician. 

Consumption is unfavorably affected by pregnancy, 
which hastens the fatal termination. The latter is not 
uncommon during or soon after labor. Women with a 
history of consumption and scrofula in the family ought 
not to marry. The great danger to life in consequence 
of pregnancy, which is often followed, if not accom- 
panied, by consumption, must never be overlooked. 

In closing this chapter I wish to draw my reader's 
attention to certain symptoms, any one of which de- 
mand the prompt and earnest attention of the physi- 
cian. With the exception of the first three of these 
symptoms, they commonly, but not invariably, precede 
convulsions : profuse diarrhoea ; discharge of blood from 
the vagina ; gush of water from the vagina : persistent. 



226 DISEASES OF PREGNANCY. 

severe headache for a number of days, especially if one- 
sided ; sudden attacks of blindness or partial loss of 
sight ; severe pain in the stomach proper, persistent 
and not distinctly traceable to errors of diet ; very 
scanty, dark urine ; bloating of face, swelling of hands 
and feet, together with a dry skin. These symptoms 
often appear in groups, and the physician should be 
promptly acquainted of them without delay. 

For domestic treatment of all hut the firsi three 
symptoms I can heartily recommend steam-baths, like 
Hi;- old-fashioned plan of placing the patient on a cane- 
seated chair, a warm blanket covering her from the 
neck down to tin- floor, and then burning rum or 
alcohol in a saucer under the chair; or hot packs 
cause profuse perspiration, and drinking aothing but 

two or three quarts Of milk a day for food. I. 
nothing else hut water is to be takm. 

Convulsions usually are due to disease of the kid- 
neys, resembling Blight's disease, and to the retention 
of urea in the system which should be excreted in the 
urine and perspiration. They occur withoul immediate 

warning, are painless, and a patient will not re; 
them. Partial blindness may ensue for a few d; 
and generally followed by complete restoration of 
sight. Free respiration, a strong pulse, long intervals 
between the attacks, and early return to consciousness 
are favorable signs. Convulsions are less dangerous 
before than after delivery. The kidneys usually become 
healthy, and a woman having convulsions once is not 
especially liable to them in a subsequent pregnancy. 
During a convulsion keep a cork with a string tied to 
ifc between the teeth, sweat the patient in a hot wet 
pack and blankets. 



CHAPTER IV. 
PREPARATIONS FOR LABOR. 

By labor is meant the contractions of the nterus and 
of the abdominal muscles, and the various processes of 
nature causing the birth of the infant. This requires a 
certain amount of preparation, which the young woman 
about to become a mother may not fully understand. 
It is true that probably the majority of women in the 
world make no preparation, and yet nearly all recover. 
It is a wise provision of Nature that she can care so 
well for her children ; yet this does not relieve any indi- 
vidual from responsibility, and it is needless to say that 
much can be done for the welfare of mother and child 
by proper preparation. 

The preparations for baby's arrival are commenced, 
as a rule, soon after it is known that he is expected. 
Baby clothing is sometimes at hand, which simplifies 
the task ; some families can spend more money than 
others, and so a definite list cannot be given for every 
individual. The writer assumes that the reader is 
inexperienced, and everything must be prepared in a 
well-to-do, but not a wealthy family. 

Cradles have been done away with, as the rocking 
of the child is believed to do more harm than good. 
The basket, also called the bassinet, has taken the 
place of the cradle. There are various ways of ar- 
ranging it, but the following directions will give a good 



228 



PREPARATIONS FOR LABOR. 



general idea, which can be modified to suit the indi- 
vidual taste. Purchase an ordinary clothes basket not 
less than about thirty inches long, eighteen inches wide, 
and ten inches deep. This should be placed on an 
ordinary box of similar dimensions mounted on casters. 
Procure four round wooden rods or rattan sticks a yard 
long and half an inch in diameter, which are to be 
upright posts in each corner of the basket, and to be 

fastened in it to Bupport 
the canopy. Unite the 
tops of the upright posts 
imilar rods, one on 
each side the Length of 
the basket, and one on 

each end the width of 

the basket. This frame- 
work is wound smoothly 
with yellow satin ribbon, 
and a fine dotted mus- 
lin stretched tighl ;t< 
the top and in folds like 
curtains around the sides 
to complete the canopy. 
The sides of the basket 
and box are covered with the same materia] in fold 
plaits. Feather stitching with yellow silk, ruffles, 
lace along the edge, or other ornaments can he ad 
according to taste. The sides of the basket should he 
padded with a sheet or two of cotton batting and lined 
with plaited silesia or satin ; light pink or a light shade 
of robin's-egg blue is a favorite color. Place a 
tick in the bottom of the basket, on top of this a thin 




Pig. 13. a Bassinet. 



PREPARATIONS FOR LABOR. 229 

tick of excelsior, or corn husks, and over this a curled- 
hair mattress and pillow. The edge of the basket can 
be. ornamented with a frill of silk and a box-plaited 
ribbon all around the rim below the frill. One or two 
rows of lace on the frill will add to its beauty. The 
sheets and pillow-case should be of old soft cotton or 
linen. A rubber sheet should not be used, unless it is 
found impossible to keep the hair mattress clean and 
sweet. If so, place a piece of rubber cloth about 
eighteen inches square over the mattress, and cover 
both with a thick layer of old flannel, and over this 
place the lower sheet. Rubber near the child's body 
causes unnecessary heat and perspiration, and should 
never be used in connection with diapers. The baby 
should be covered with flannel blankets, which can be 
made very dainty and pretty in the following manner : 
select California flannel of a heavy quality alike on 
both sides with a thick, loose pile. Make the blankets 
seven eighths of a yard long; and the width of the 
flannel ; buttonhole them around the edge with crewel 
to match or harmonize with the lining of the bassinet. 
The corners of the blankets can be worked in some 
design according to taste. Roses are often selected for 
the pattern. 

The baby basket in which are kept the various 
articles for baby's first and subsequent toilet should 
correspond in general with the bassinet. 

The accompanying description and illustration are 
taken from Babyhood, an excellent magazine devoted 
to the care of infants. Two layers of cotton wad- 
ding are placed over the bottom of each basket with 
a little sachet powder sprinkled between them. Cover 



230 



PREPARATIONS FOR LABOR. 



the sides and bottom smoothly with fine light blue 
silesia, or a color similar to that lining the bassinet. 
Cover the bottom again with a smooth piece of fine 
muslin. Take a strip of the muslin a little wider than 
the depth of the basket, and edge both sides with v< 
fine Torchon lace-; shirr it to the top and bottom of the 
sides of the basket, leaving an inch ruffle standing above 
the upper edge. There are in the upper basket three 
straw pockets, two seven inches long at the sides and a 

shorter one at the end, fas- 
tened by pale blue satin rib- 
bon, which firsl is sewed 
firmly to the sides of the 
basket, then has it- ends 
brought through holes in the 
hack of the pocket and is tied 
in pretty hows on the inside. 
At the other end is a square 
pincushion, covered with the 
silesia and muslin, trimmed 
with lace, and further orna- 
mented on the corner b 
The sponge hag hangs at one 
side by two pieces of ribbon three quarters of a yard 
long, the two ends of each ribbon being fastened to 
diagonally opposite corners of the hag. This i^> a piea 
of silesia eight inches square, lined with oiled -ilk. 
covered with muslin and hound with the narrow ribbon. 
There are also small bows of ribbon on each corner. A 
fine sponge, which is especially useful for the head, is 
placed in the bag ; a thick soft brush in one pocket and 
a small comb in another, safety pins. etc.. in the 




Fig. 14. Baby Basket. 



bow of satin ribbon. 



u- 




\ 



<m 



\ 



J, , ,„.-..». IV 



PREPARATIONS FOR LABOR. 231 

cushion. In the basket is laid a porcelain puff-box 
with flowered front ; French gilt rims and pale pink 
puff showing through the glass cover add greatly to 
the prettiness of the general effect. 

The articles for the first toilet of the baby should be 
placed in the basket, so as to be in readiness at the time 
of confinement, and may be enumerated as follows : 
one complete Standard suit ; if this be not used, these 
five articles are to be substituted : one nightgown, 
one cambric skirt, one " barrow coat" or "pinning 
blanket," one linen shirt, one soft flannel shirt ; in 
addition to the preceding list there should be a square 
of fine white double- width Shaker flannel bound with 
ribbon, like that of the basket and bassinet, for a shawl ; 
one flannel band ; two diapers of old linen, one very 
small ; three pieces of tape one eighth inch wide and 
twelve inches long, or a skein of coarse white em- 
broidery silk or dental floss ; a pair of sharp scissors ; a 
small jar of vaseline ; a thermometer for measuring 
the temperature of the room and of the bath ; a piece 
of old castile or olive- oil soap ; one linen and one old 
flannel wash-rag ; two very soft towels ; a large, old 
flannel apron ; a box of baby powder with a puff ; rice 
powder is the best, as starch is more subject to decom- 
position, and may irritate the skin. A fine starch 
powder is made by rubbing starch and alcohol into a 
paste in a saucer. The alcohol evaporates and leaves 
a delicate powder. A roll of very fine, soft old linen ; 
a paper of ordinary pins, and two sizes of safety pins. 
Ladies sometimes procure a few solid silver or gold 
plated safety pins. Starch, ruffles, or puffs should not be 
allowed in any garment which touches the baby's skin. 



232 PREPARATIONS FOR LABOR. 

Tlie first clothes (the layette) for the baby are made 
in various ways. The author recommends the Standard 
suit with some slight modifications according to the 
climate, hut as the reader may prefer the old style of 
dress, the articles for the latter are enumerated on page 
230, after the description of the Standard suit. Dr. L. 
C. Grosvenor, of 185 Lincoln Avenue. Chicago, has in- 
troduced the Gertrude suit, which is very similar to the 
Standard. He will send the five patterns of the suit. 
postpaid, for one dollar, or the standard pattern sheet 
shown here can be obtained of the Hygienic Publishing 
Co., 15 Milton Place, Boston. Mass., for fifteen cents. 

The accompanying pattern sheel contains the full 
size of the patterns in outline ; each one can he followed 
and traced <>ut separately en thin paper by following 
the outline of each pattern. 

.1. Dress. The four sections show half of the 
iVout. half of the hack, and tw<> parts of the Bleeve. 
This is a plain slij> ; if desired t-» elaborate it with tucks 
and trimmings down the trout or aboul the bottom, 
allowance must he made for th< 86 in cutting. Any style 
of dress can he used with the Standard undergarments, 
either yoke, Mother Hubbard, etc. according to fancy. 

B. Unkerskirt (t><<I Nightgown. These two gar- 
ments are alike and (ait by the safne pattern, and take 
the place of shirt, pinning blanket (barrow coat), 
and hand. The three sections show half of the trout. 
half of the hack, and the sleeve. A tine quality of 
cotton flannel of medium weight is excellent material : 
hut the white all-wool, widest width, heaviest weight 
stockinet made by the Jaeger Sanitary Woollen ( 
and sold at 827 Broadway, New York, is the most 



PREPARATIONS FOR LABOR. 233 

desirable. Seven eighths of a yard is required for a 
garment, and three or four garments are sufficient. 
The hem of the neck, waist, and bottom is turned over 
with a broad edge on the outside and catstitched. If 
the skirt and waist are made separately, use one breadth 
of flannel for B and two for C. It is a good plan to 
have a plait an inch wide down the front and about 
the bottom, to allow of letting out as the child grows. 
The nightgown and the diaper usually are sufficient 
for night wear. 

C. Flannel Skirt. The two sections showing half 
of the front and half of the back are made of woollen 
flannel, without sleeves, the armholes and neck scalloped 
but not bound. Ornament the bottom according to taste. 

D and E. Diapers. There are two sizes, 18x18 and 
10x10 inches, the larger to be folded across diago- 
nally to an even triangle. The smaller one is placed 
where most needed, inside the folded diaper. It saves 
the heat, discomfort, and unnecessary thicknesses about 
the child, besides reducing the size of the pieces for 
washing. Soft, old linen diapers made from old table- 
cloths are the best, though some prefer cotton flannel, 
as softer and warmer. Take care to turn the hem on 
the right side, and use the fleecy side next to the baby. 

Use of Knit Goods. — A very fine texture of absorbent 
jersey fitted to the body by a gore running down the 
centre, as in Fig. 17, is more elastic and less clumsy 
about the hips than the old style of diaper. If a little 
Hartmann's wood wool is quilted coarsely between folds 
twelve inches square of ordinary cheese-cloth which 
has had the starch boiled out of it, and used instead 
of the small napkin, it will save a good deal of washing, 



234 PREPARATIONS FOR LABOR. 

as these pads are burned when soiled. Never use rubber 
diapers or drawers ; they cause excessive perspiration, 
and indirectly are likely to harm the baby. 

The first three garments are made princess fashion, 
and one fits neatly into the other, so that all three can 
be put on or taken off the baby as one garment. The 
washing of flannel garments, so that they will remain 
soft and not shrink, is of no little importance for the 
comfort of the baby, silk and wool mixed is preferred 
by sonic mothers to an all-wool fabric, especially for 
summer clothing, as it is not so warm. 

The Novelty Knitting Co., of Albany, New York. 
have made a knit Gertrude suit which will warmly 
■ecommend itself to some 
mothers. The same firm 
has pui a knit diaper on 
the market which adjusts 
itself to the baby, and 
^StnM* ia more elastic than the^C 8 ^ 
old style of diaper (Figs. L5 and 16). The tit about 
the waist is improved by goring the diaper after it is 
folded diagonally as in Fig IT. 

A simple way of cleansing flannel i^ t<> -oak the 
garments fifteen minutes to half an hour in boiling 
water and borax, — a teaspoonful of borax to a quart of 
water. Rinse them in water of the same temperature. 
Squeeze them gently, dip them up and down, hut 
never rub or wring the flannels, nor allow them to 
remain wet or to freeze dry. Pull the garments into 
shape when drying, and when but a trifle damp pi 
them with a hot iron. If there are delicate colors or 
the borax is not at hand, use in the same way half 





PREPARATIONS FOR LABOR. 



233 



a teaspoonful of ammonia to a quart of water. Wash 

all silk articles in cold water. A more complicated 
method of washing flannels, which admits of more 
thorough cleansing, is as follows : shave up one bar 
of Ivory soap and dissolve it in two and a half gallons 
of boiling soft water : turn it into a three-gallon jar. 
add one ounce of borax, three teaspoonfuls of sal 
soda, and stir ammonia enough in it to give it a 
strong odor : cover it up and set it away to cool, when 
it will resemble soft soap. Add enough of this soap 




Fig. 17. 

mixture to clear, warm, soft water to make a suds ; 
wash one garment at a time : rinse it in clear, soft warm 
water and hang it up at once. The use of clear, soft 
water is essential for success, exactly as directed. 
Directions for washing the Jaeger flannel come with it, 
and should be observed faithfully in cleansing garments 
made from it. Diapers are often neglected by the 
laundress, are soaked in strong soapsuds, imperfectly 
rinsed, starched, and ironed. All of these are things 
which must not be done. Great care must be taken to 



236 PREPARATIONS FOR LABOR. 

thoroughly rinse the diapers ; never starch them, nor 
allow a nurse-girl simply to dry diapers soiled by urine 
and to put them on the child. All soiled linen needs 
washing. Press out lightly the wrinkles in these gar- 
ments, but do not iron them in the ordinary sense of the 
term. Never allow starch in anything which comes 
next to the baby's skin. 

The Standard suit, as a whole, is the best one at 
present for a baby to wear: hut there are some modifica- 
tions which can he adopted to advantage, and depend 
chiefly on the circumstances of the individual case. In 
a cold climate and in the winter it is a good plan to 
make full-length sleeves of ample dimensions t«> pro- 
vide for the growth <>f the arms; the ends of the 
sleeves can he finished with wristlets made from 
drawers ribbings, or the ribbing of an old undervest, 
stretched as it is sewn with the ravelling edge on the 
end of the sleeve. These wristlets protect the arms 
from draughts of air, and prevenl the Bleeves from riding 
up. A light <»r heavy flannel should he used, according 
to the season. The Jaeger stockinet cuts to better 
advantage with the straight edge of the hack of the 
pattern on the selvage of the flannel and making a 
Beam below the buttons. If a baby is restless nights 
and kicks off the clothing, the nightgown can he made 
a little longer and fuller, and the bottom buttoned 
together. A combination shirt and drawers night suit 
is better for children old enough to walk about a little. 
If the feet are cold, long stockings covering the entire 
limbs can be worn with elastic tapes sewed on to them 
and buttoned to the shoulder-strap. This plan has 
been adopted by some mothers who cut the Standard 



PREPARATIONS FOR LABOR. 237 

day suit only twenty-two inches long. It practically 
short coats the baby from the beginning. The long 
stockings are made warm enough to protect the limbs, 
and the mother is saved the trouble of making more 
clothes a few months later. The writer cannot recom- 
mend such short clothes for the winter, though they 
might do for the warm summer months. If the Jaeger 
stockinet irritates the skin, which is very unlikely, or 
is too expensive, a very soft cotton flannel, merino, or 
linen shirt can be used next to the skin beneath the 
flannel dress. The baby is dressed easily by pinning on 
the diaper and putting on the three garments as one 
piece, turning the baby over once and buttoning up 
the back. Stockings are put on afterwards, if they are 
necessary, to keep the feet warm. This suit admits of 
dressing with ease, rapidity, and comfort for the child ; 
it does away with all pins, except the diaper pin ; it 
admits of ready inspection of the child's body ; lastly 
and important, it does away with all bands, for with 
this suit no belly band is worn after the navel has 
healed, i. <?., after ten days. This band is not needed 
to support the abdomen, is difficult to keep in place, 
and is often a serious injury, causing rupture (hernia) 
when applied too tight. A properly fitting bellyband 
is recommended to protect the abdomen from changes 
in atmospheric temperature during the summer in a 
changeable climate, especially if the baby is teething, 
being artificially fed, or suffering from looseness of the 
bowels. Except for these indications, the bellyband 
ought to be dispensed with after the tenth day, if the 
navel has healed perfectly. 

The best bellyband is made by tearing across the 



238 PREPARATIONS FOR LABOR. 

flannel or cutting on the bias a strip five inches wide 
and eighteen inches long. If the hand is too long to 
lap well, cut it off ; leave the edge rough and unsewn ; 
feather stitching makes it harsher for the baby. A 
little tab of cloth should be sewn on in front, so that it 
can be pinned to the diaper and kept in place Knitted 
bands or shirts arc better, in thai they lit the abdomen 
more closely and are more elastic than ordinary flannel 
bands. They are knitted loosely in strips from Saxony 
yarn on medium-sized knitting-needles in the old-fash- 
ioned garter stitch, and then darned together to avoid 
seams. Bands are commonly worn till the child is Bis 

months old, unless the reform (Standard) suit is u^'<\. 
though the latter does not interfere with the hand: it 
is only because the band is unnecessary, except as stated 

above. 

The following articles should be prepared for baby's 
use. A mother can manage with a smaller number, and 
if in a rih lent circumstances she will ueed more garments, 
especially diapers, if the baby ever has diarrhoea : — 

Two squares of fine white double-width Shaker 
flannel bound with ribbon, of extra flannel dresses with 
cap' 

Ten Long white dresses (Standard pattern). 

"Four silk warp or fine flannel skirt- (Standard 
pattern). 

Three fine flannel nightgowns (Standard pattern) 
with full skirts buttoning- at the bottom. 

* Three Jaeger stockinet underskirts (Standard pat- 
tern). 

Four bellybands or knitted shirts. 

Thirty small diapers, unless quilted pad- of wood 



PREPARATIONS FOR LABOR. 239 

wool and cheese-cloth, or one eighth pound of absorbent 
cotton to a pad are used, when fifteen small napkins 
are sufficient. 

Thirty large diapers. 

Twelve bibs. 

Four pairs woollen stockings reaching above the 
knees, and either pinned to the diaper or attached by 
elastic bands to the shoulders. 

One half -gross large safety pins. 

One gross small safety pins. 

If the Standard suit is not used, omit the starred 
articles from the above list and substitute — 

Four fine flannel barrow coats (pinning blankets). 

Four silk- warp flannel or knit worsted shirts. 

Four linen or silk shirts to wear beneath the flannel. 

If babies will not sleep with the bottom of the night- 
gown buttoned up, and yet kick off the clothing so as to 
expose the limbs, and also when they are able to walk, 
try making a combination of loose waist, drawers, and 
stockings in one piece. Heavy or light weight flannels 
are worn suitable to the season. 

The thin all-wool nightgown and diaper are suf- 
ficient for night wear, except in cold weather and 
insufficiently heated rooms (i. e., less than 60° for a 
young baby). A thick- weight flannel nightgown should 
be worn, or a second flannel nightgown put on, which 
is exchanged for a calico wrapper in the spring. A 
very young child, unable to turn about, can be wrapped 
in a light soft flannel outside of its clothing, which is 
exchanged later for a wrapper of "wash flannel" or 
the nightgown to keep the shoulders warm. Mothers 
who do not use the Standard suit can dress a balp* 



240 PREPARATIONS FOR LABOR. 

about four months old at night in a knitted worsted 
shirt, band, diaper, barrow coat or pinning blanket 
(i. e., a long flannel skirt open behind), and a night- 
gown. Put on a flannel wrapper over the nightgown 
in winter, the long flannel sleeves coming down over 
the hands. All the garments should be very loofl 

Short coating the baby, t. e., putting it in short 
clothes, is to be regulated by the season rather than the 
age of the infant. Cold weather is an unfavorable 
time, as thf baby may suffer from it. Short coating is 
practised as early as three and as late as eight months. 
The usual length of the dress l'<»r one year is twenty- 
two inches. Attention has been called already to 
making the Standard suit this length from the be- 
ginning, ami using long -locking- to keep the legs 
warm, which are unnecessary with the long skirts. 
The same number of garments are used in the short 
suit as in the long, but long stocking- are added, fastened 
to the inside of the diapers with a shield pin, and the 
undergarment is made of a soft, medium-weight Canton 
flannel. 

Our grandmothers, who did their own work and 
cared for their children without nurse-girls, were 
accustomed to use standing stools, and as such an 
article would be a great convenience in some families 
at the present time, a description of one i- given. It i- 
really a miniature crib which can be taken from one 
room to another, and holds the baby safely in sight. 
while the mother is doing her work. After baby can 
stand and walk well, a belt about his waist and a strong 
cord to time him up will give him more freedom and 
safety. 




PREPARATIONS FOR LABOR. 241 

The simplest standing stool is an ordinary box 
thirty inches square and about sixteen inches deep, lined, 
padded, and mounted on casters. The pattern described 
is a very old one and one of the best. Cut the oyal 
bottom twenty-five by seventeen inches, from a two 
and a half inch hard-wood plank. Fit 
it with twenty -one rods, half an inch 
in diameter, and nineteen inches long, 
and a railing for the top two inches 
wide, carefully rounded and polished 
so that the baby cannot scratch him- 
self. Place a soft mat or carpet in the FlG - 18 ' stmd ^ stooL 
bottom, and baby can be kept in on a table off from the 
cold floors, out of mischief, perfectly safe and easily 
watched. 

The preparations a woman makes for herself are 
simpler than those for the baby, and too often are 
delayed till the latter part of pregnancy. The room 
in which she expects to be confined cannot be selected 
always, yet, so far as possible, it should be free from 
disturbing noise or odors, dry, sunny, well ventilated 
by windows, and a fireplace improves it, but without 
draughts of air. It should be possible to keep it 
well warmed both day and night if necessary. It 
ought not to be on the first floor or over a damp 
cellar with the air blowing in and up through the 
floor in all places. Better have a bare floor than one 
with a cold oilcloth to step on. 

If there are any set bowls in the room communi- 
cating with the sewer, seal them up carefully by past- 
ing paper over the large hole in the bottom of the 
bowl, and the small holes at the top ; never trust to 



242 PREPARATIONS FOR LABOR. 

traps, however well the plumber may warrant them. 
If there is a door opening into the bath-room it 
should be locked, and all the cracks carefully pasted 
over with paper, and the bath-room entered from the 
hall. This may seem quite superfluous, but the im- 
portance in guarding against every possible source of 
disease cannot be emphasized too strongly. 

If any person lias boon sick in the room within two 
years with any infectious disease, severe erysipelas, or 
any surgical disease attended by the formation of mat- 
ter, i. e., pus, the room must nol be used, on account of 
the danger of childbed fever. It more than two years 
since any of the above diseases have occurred there, never 
trusl to any disinfection, however thorough at the time. 
but redisinfeel the room in the following manner, with 
all the furniture in the room ;is it will he occupied dur- 
ing labor, hut remove ;ill the silver, as it will tarnish. 
I )pen all the drawers and closets, close the draughts and 
windows. For every one thousand cubic feet of air buy 
three pounds of brimstone t«> hum in the room six hours 
as follows: take a large pan and place a couple of 
bricks tlat in it. pom- in enough water to cover the 
bricks, and place on them another small tin or iron dish 
containing the brimstone. When all is ready, pour two 
tablespoonfuls of alcohol on the brimstone, light it with 
a match, and leave the room for six hours : at the end 
of that time enter the room, and, without breathing, 
open a window, and leave it for a couple of hours, when 
it will be sufficiently ventilated to remove the pans. It 
does no harm to look occasionally into the room to 
if everything is all right during the fumigation, but if 
the latter is well under way it is better not to enter. 



PREPARATIONS FOR LABOR. 24:3 

The process is quite safe and not likely to injure any- 
thing, except starched clothes. It has no effect on 
bronze or gold-leaf picture frames ; it might injure 
very cheap gilt or silver frames or delicate dresses. The 
peculiar odor of the sulphur fumes is quite penetrating, 
and. in spite of thorough ventilation, may persist for 
a fortnight. For this reason the room should be fumi- 
gated three weeks before labor is expected. 

Should a choice of beds be practicable, select one 
which stands well up from the floor. Low beds try the 
backs of physician and nurse. A two-thirds bed is a 
good width, and an ordinary width bed is much better 
than a very wide one, which requires the nurse to do 
much reaching. 

The rules for a previous illness of any one occupying 
the bed are the same as for the room. A feather bed 
must not be used. A hair mattress is the best, and 
should be thoroughly cleansed by naphtha previous to 
confinement. Both sides of the bed should be accessible ; 
if only practicable on one side, it ought to be the left- 
hand side facing the headboard. 

An old blanket, or rug wrong side up, on the floor, 
at the left-hand side of the bed, serves the excellent pur- 
pose of protecting the carpet. 

The following list of articles will be needed at the time 
of the confinement : one rubber or oilcloth 4x4: feet will 
do, but an extra rubber will be convenient ; a fresh, 
clean fountain syringe ; a Eureka bedpan is very desir- 
able, its shape being the best with which I am ac- 
quainted, and it also saves much lifting ; towels, nap- 
kins, sheets ; one eighth pound absorbent cotton, one 
bottle of fresh sweet- oil, one cake of pure imported 



244 PREPARATIONS FOR LABOR. 

castile or olive- oil soap, one bottle of antiseptic mercurial 
tablets (Wyeth's), a small bottle of brandy ; old shi 
are better than new ones, and there must be blankets 
enough to change, so that one set is airing while the 
other is in use ; a foot-tub is convenient in which to 
place the soiled linen. 

The mother will need for her personal use three or 
four nightgowns and as many day gowns, opening all 
their length in front, one dressing sack, six binders 
eighteen by forty inches, simply torn from strong 
cotton cloth without selvage edge or any stitching, 
and two napkins fifteen by thirty inches. The antisep- 
tic pads 1 made in the following manner are better 

than the ordinary nap- 
kins. Procure sun gauze 
or cheese-cloth in the 
piece ; twenty yards will 

lla.tt. Baraks Bedpan. not he too milch. Boil 

and wash the starch all oul of it without using soap 
or anything but water. Dry in pure, fresh air, free 

from odors, and iron with a very hoi flat, hot enough 
so that it has to be moved rapidly to avoid scorch- 
ing the fabric. It can now be cut in pi as 
to he folded together in pads four inches wide, ten 
inches long, and ten or twelve layers. thick. The pad 
made in this way can be seemed well enough by two 
or three basting stitches, or it can be loosely basted on 
a strip of cotton flannel four inches wide and twenty 
long. If made the latter way. the ends of the cotton 
flannel are secured by safety pins to the hinder, and 



1 These pads can be purchased ready for use <»t Otis Clapp A 9 
Codman & Shurtleff, Boston. 




PREPARATIONS FOR LABOR. 245 

thus hold the pad loosely against the private parts to 
receive the vaginal discharges. 

If the pads are not attached to the flannel, they are 
used hy placing them in a napkin, which is secured the 
same as the ends of the flannel. I prefer the use of the 
flannel strip. When the pads are removed they are 
burned at once, and thus much washing is saved. Fifty 
of these pads should he in readiness. In case they are 
not all used, the patient will find them very useful for 
menstrual pads. 

A simpler way of making the pads is to procure one 
pound of Hartmann's antiseptic wood wool. Prepare 
the cheese-cloth as before but in fewer layers, and insert 
between them a handful of the wood wool for a pad. 
An obstetric sheet of the same material, about two feet 
square and quilted an inch and a half thick, is excellent 
for the hips to rest upon during labor. It is softer than 
the folded sheet and cloths commonly used for that 
purpose, and is especially valuable to absorb the dis- 
charges. The medium size, sold for about seventy -five 
cents, is large enough to absorb all the discharges during 
an ordinary labor. 

A cot bed in the room for the nurse to sleep on is 
convenient, but not absolutely necessary. 

The bed is made as follows for the patient to occupy 
during her confinement: pin the rubber with safety 
pins to the mattress, the edge of the rubber cloth com- 
ing over the left edge of the mattress as you face the 
bed. and also covering the middle of it. Spread the 
sheet on this in the usual way, and over the sheet place 
the second rubber cloth, if there is one. so that one 
border will lie over the left edge of the bed. and where 



246 PREPARATIONS FOR LABOR. 

the patient's hips will lie a little below the centre of the 
rubber. Place the antiseptic wood wool sheet on this 
or on the sheet, if there is not a second rubber, or an 
old blanket or sheet folded three by four feet, the long 
way of it along the margin of the mattress, and its 
lower edge so that it will lie not more than a foot below 
the genitals; then, as this sheet becomes soiled, it can 
be pulled down and its Lower edge folded over, so that 
the patient will lie on a comparatively clean sheet, and 
the bod will remain fresh. Napkins should be at hand 
to soak up any sudden gush of fluid, and a small oblong 
bavin is convenient to receive the afterbirth as it is 
discharged. 

Send for the physician as soon as the pains of labor 
appear at regular intervals. The regularity of labor 
pains, doming at uearly exact intervals of time which 
are entirely free from pain, is the greal characteristic 
feature of true Labor pains. They usually commence 
low down in the back and streak over the hips to the 
region of the bladder. If the hand is placed flat and 
firm on the uterus during a pain, the uterus will feel 
much harder than when there is no pain. 

False labor pains often mislead a woman and cause 
her to send needlessly for the physician. Such pain- do 
not appear at regular intervals, are net associated with 
hardening of the uterus, and are in the upper part of 
the abdomen rather than at the lower part of the spine.. 
The pain itself is colicky in character and is often duv 
to constipation. A good rectal enema of lukewarm 
castile soapsuds, with free evacuation of the bowel-. 
will afford prompt relief for most cases. 

Take particular pains in sending for a physician to 



PREPARATIONS FOR LABOR. 247 

leave the address correctly, and a careful statement of 
the case concerning any symptoms which may have 
occurred, such as a gush of water or bleeding, and 
also state the severity and frequency of the labor pains. 
Such a statement is often of considerable help to a 
medical man. 

Just before the doctor is expected, the nurse should 
have at hand a basin of warm water, soap, nail-brush, 
towel, and vaseline or glycerine. I much prefer 
glycerine, as vaseline is not easily washed off the 
hands and is very difficult to remove from clothing. 
At the commencement of labor the nurse also should 
take pains to have convenient a supply of hot and cold 
water, a bowl the patient can vomit in if she should 
be so inclined, a chamber vessel, a bedpan, and a foot- 
tub or another receptacle for soiled clothes. A dozen 
napkins should be near at hand. . 

Tn engaging a nurse care should be taken to have 
the dates and wages carefully arranged, i. e.. amount of 
pay, if any. if there is a miscarriage, and when there 
is no use for the nurse at the time for which she is 
engaged. Confinement is sometimes delayed beyond 
the expected time : for this. too. the compensation of 
the nurse should be arranged, and. finally, engage the 
nurse for a distinct period after confinement. Thi^ 
should be at least four weeks : even then it will be no 
small task for a woman to assume the care of herself 
and child, not to mention that of the household. It 
adds much to a woman's comfort to have her hair done 
up while she is in bed. Comb it high up on the head 
and braid each half tightly the full length and tie the 
ends : coil these braids from ear to ear entirely on top 



248 PREPARATIONS FOR LABOR. 

of the head ; do not cover the back in the least, and 
fasten the braids with long smooth hairpins. The hair 
onght to remain in place a week and look well. Before 
combing it, get out all the snarls in the short hair about 
the neck and face. Dampening the hair with alcohol 
and water will help take out the crimp and snarls. 



PLATE XII. 

A Head or Cranial Presentation. 

This is a correct representation of the child in the uterus as it presents in ninety- 
five per cent of all cases. The placenta is seen attached to the uterus near the child's 
foot. The black next to the child is the liquor arani surrounded by a light dotted line 
next to the uterus which is the bag of membrane. The uterus is external and among 
the intestines. 



CHAPTER V. 
LABOR. 

By this term is meant that combination of Nature's 
forces which produces the birth of the child. It is to 
be remembered that the infant is born purely as the 
result of muscular contractions of the maternal organ- 
ism and chiefly of the litems, which is essentially a 
hollow muscle. The child is purely a passive agent, 
and never in itself makes any movement to aid its 
birth. 

Before the infant is born it lies in the cavity of the 
uterus surrounded by a fluid similar to water which is 
enclosed by a thin, paper-like, semi-transparent bag of 
membranes. Half floating in this fluid, any portion 
of the child may be lowest in the pelvis and be the part 
to be born first, if the circumstances will permit. As the 
head is both the largest and heaviest part of the child, 
it almost always sinks to the bottom of the uterus and 
thus becomes the presenting part. | See Plate XII. | It 
is always the head which causes the chief difficulty in 
expelling the child. Sometimes the child does not. as 
it were, stand on the head, but its buttocks are lowest 
in the uterus, i. c. it sits in the pelvis. It then con- 
stitutes a breech presentation, i Plate XIII. | Rarely 
the child lies across the uterine cavity and the pelvis. 
It i< then a cross birth or transverse presentation, and 
the child must be turned so that one end of the child. 



250 LABOR. 

usually the breech, can enter the pelvis and allow the 
child to be born. (Plate XIV.) In any of these three 
chief forms of presentation the back may be anterior 
or posterior. It is always better for the back to be 
anterior ; almost always, if it is behind, the child lias 
to turn so that its back will come in front, and this 
causes considerable increase in the length of labor and 
extra pain. Head presentations occur in ninty-five per 
cent of all cases, and arc by far the most favorable of 
all the presentations of the child. Breech presenta- 
tions are equally favorable for the mother, but are not 

nearly as good for the child, as the head is apt to stick 

in the pelvis, and the child dies from suffocation before 
it can be extricated. This unfortunate termination of 
labor is moM coiiiinoii in a firsl childbirth it' the breech 
presents. A rare form of crania] presentation is for the 
back of the child's head to rest between its shoulders, 
so that the face instead of the top of the head is born 
fust. In all the various positions mentioned the body of 
the child in the uterus is bent a little forward, with 

the arms folded over the chest, and the limbs flexed on 
the abdomen. Twins may present in any of these 
positions, but more often one presents by the head 
and the other by the breech. The second child is usually 
born easily and within half an hour after the birth of 
the first one. (Plate XV. | 

The duration of labor must necessarily depend on 
many factors and be very variable, yet, on an avers 
of many cases, a woman is in labor with her first child 
eighteen hours, and if she has children again the 
average time is twelve hours. Rather more than two 
thirds of the time is occupied by what is known as the 




PLATE XIII. 
A Breech Presentation. 




PLATE XIV. 

Transverse Presentation. 



LABOR. 251 

first stage, which really ought to be considered the 
preparatory stage of labor. The first labor is longer 
than subsequent ones, for the reason that the muscles 
and ligaments are stretched for the first time and yield 
more readily afterward. After thirty years of age it is 
more difficult to give birth to the first child than earlier 
in life, as the parts are then more rigid. The expulsive 
pains vary much in different cases, sometimes strong, 
at other times poor ; and this is true, too, of each indi- 
vidual case. The presentation of the child also makes 
a difference in the length of labor ; twin cases require 
more time than a single birth. One child is commonly 
born within half an hour after the first, but the first 
stage of labor is prolonged. Large children require 
more time to be born than small ones, and babies with 
very hard heads more than those with heads which 
yield a little and become elongated. 

A few days before labor begins there is an increased 
leucorrhceal discharge from the vagina ; greater fre- 
quency of urination is experienced ; the child is often 
not so vigorous in its motions, and the height of the 
abdominal swelling is lower down. Labor varies much 
in the way it begins. In some women it commences 
suddenly and vigorously without any warning, in others 
it commences gradually with an occasional twinge of 
pain in the back or uterus. 

For convenience of description, the act of parturi- 
tion is divided into three periods, known as the three 
stages of labor. The first stage may be considered 
preparatory, and lasts till the womb has dilated enough 
for the child to escape through its neck, and is com- 
monly terminated by the spontaneous rupture of the 



252 LABOR. 

bag of membrane during a pain, and a gush of watery 
fluid, the liquor amni. 

The second stage of labor, characterized by severe 
bearing-down pains, is from the end of the first s1 
to the birth of the child ; and the third stage corresponds 
to the time occupied for the expulsion of the placenta 
(afterbirth) after the child is born. The duration of 
each period, like the duration of labor, is very variable 
and may last from a few minute- to many hours, 
even days, but the following gives an average time : 
first stage, twelve hours for the first child, eight hours 
if in labor a second time; second stage, six hours for 
first baby, two to lour hours for another child ; third 
stage of labor, from five to forty minute* 

The preparations for childbirth h ibed, 

and should be completed when parturition commeni 
Details already mentioned need not be repeated in 
describing the symptoms and management of the first 
stage. Labor commences with pains low down in the 
back extending over into the uterus, which appeal 
regular intervals with entire remissions or spa* 
from pain. The pains gradually in< in strength 

and frequency till the child is horn. In addition to this 
main symptom, three others occur which should he 
understood as perfectly natural and not a cause for any 
anxiety ; all three of them are most likely to occur near 
the completion of the first stage, though one or all of 
them may not appear. The first symptom is what 
seems to be a chill ; the patient shudders, often sh 
violently, and complains of cold. This is analogous to 
the shudder sometimes experienced at the close of 
urination, and is purely of a nervous character from the 




PLATE XV. 

The Position of Twins in the Uterus. 



The navel cords are about the waists, and they are separated by the bag of mem- 
brane. 



LABOR. 253 

dilatation of the uterus. An extra blanket, and a hot- 
water bottle to the feet, are all that is necessary. The 
second symptom is a slight bloody discharge varying 
from a few drops to a teaspoonful (more than this, or 
a constant bloody discharge, may mean a serious com- 
plication requiring the careful attention of the physi- 
cian^, called a show, which is due to the breaking of a 
few capillary blood-vessels. The third symptom, vom- 
iting, is very common. This, like the chill, is purely of 
a nervous character and is perfectly natural, but when 
it occurs late in the second stage of a very long and 
painful labor it means exhaustion. The membrane 
ruptures in most cases when the first stage is completed, 
but this may happen any time previously, and, the 
waters gradually escaping, causes what is called a 
dry labor, which lasts longer than ordinary parturition. 
In rare cases the membrane does not rupture so that the 
child can pass through it, then the child is born with 
its face and head covered with this membrane, which 
must be immediately torn off — there is no risk in doing 
it — or the infant will at once suffocate. The mem- 
brane, under these circumstances, is called a caul, and 
superstitious sailors once were firmly of the opinion that 
the owner of a caul would never drown. 

It may seem needless to remark that all coarse jest- 
ing is quite out of place in the lying-in room ; quiet, 
attention, and sympathy for woman in her hour of 
suffering should be the rule, and not more than two 
other persons should be in the room. A good nurse is 
much more efficient if she is not a near relative, as the 
sympathy and natural nervousness of the latter may 
unfit her for her duties. The husband should be 



254 LABOR. 

admitted to the lying-in chamber if the wife desires it. 
but not otherwise. Children and young people ought 
to be away from the house. 

There is no definite rule about going to bed early in 
labor. If the patient is up and walking about in the 
room or sitting in an easy-chair, it will be quite as well 
for her as going to bed, and labor will not seem so long; 
but if she feels tired and exhausted, there is no reason 
why she should use up her strength in walking about, 
even though the upright position favors the descent of 
the child. We must follow Nature's lead and allow her 
to take such positions as are the most comfortable. 
Care must be taken to save both nervous and muscular 
strength in every way. she must not strain or bear 
down in this stage, and never pull on anything to fo 
the child down, as the time has not come. [f she can 
obtain a little slc.-p or rest between the pains it is ex- 
tremely desirable. Quiet and sometimes stroking the 
patient lightly with the hand or gently fanning her will 
aid this much more than constantly reminding her b 
to sleep, which will almost certainly insure wakeful- 
ness. Every minute of sleep is a blessing only realized 
by those who have experienced it. We can not only 
save a woman's strength in this manner, but can give 
her a source of more strength in the shape of small 
quantities of food at short intervals. Even if it is 
occasionally vomited, some nourishment will be ab- 
sorbed. Milk, the white of egg beaten up with a little 
water, Mellin's food, beef juice squeezed out of a rare 
steak, chicken soup, etc., afford a good supply of food 
which is likely to be retained and digested. 

The dress must be so arranged that the outer clothing 



LABOR. 255 

can be removed instantly without difficulty. Have the 
nightdress folded up from the bottom to very near the 
armpits and securely pinned there with a safety pin ; 
then fold a sheet or a thin blanket over a belt and wear 
this as a skirt. The belt must be so arranged that it can 
be readily unfastened. A skirt open on the right side 
and pinned to the nightgown for support can be sub- 
stituted for the folded sheet and belt. Over this a loose 
wrapper can be worn if the woman is walking about. 
She will also need to have on warm stockings and com- 
fortable slippers. An extra large napkin should be 
worn, but not piuned on very tightly. 

A large enema (two or three pints) of warm castile 
soapsuds must be taken as soon as possible when 
labor has begun. A free evacuation of the bowels 
adds much to cleanliness later in labor, besides, an over- 
loaded rectum presents some resistance to the passage 
of the child, and needlessly increases suffering. Toilet 
paper will not sufficiently cleanse the parts after a 
fecal movement ; washing them with a cloth and dry- 
ing them is the proper management. The use of this 
enema must not be neglected, even if the bowels have 
been loose, or have moved a short time previously. It 
is hardly necessary to say that all discharges must be at 
once removed from the room, as absolute cleanliness is 
essential to health. In case there is much constipation, 
and the fecal masses are hard and difficult to remove 
with water, use an injection of a tablespoonful of sweet- 
oil, a tablespoonful of glycerine, and a pint of warm 
water. Inject this very slowly into the bowel and press 
a folded napkin against the anus to assist the retention 
of the enema. In an hour the fecal masses will be 



256 LABOR. 

softened by the oil and glycerine, and a second large 
enema should be given to fully empty the bowel. 
Always warm and oil the nozzle of the syringe before 
introducing it. The movement from the bowels must 
be invariably over a chamber or sick-chair, and never 
over the water-closet during parturition. After the 
first stage of labor is completed, the patient must not, 
under any circumstances, leave the bed t<> attend to the 
calls of nature ; the discharges can be received in the 
bedpan or on cloths. Many serious accidents have 
happened from the unexpected birth of the child and 
neglect of the above precaution. Care must he taken to 
pass urine at short intervals to keep the bladder empty . 
When the doctor desires t<> make an examination, 
tlie patient will do well to ask whether he de-ires her 
to lie on the hack or side. In the former case, -he will 
lie on her hack near the edge of the bed, with her kmvs 
drawn up and eighteen inches apart, with only the 
sheet or hlanket thrown over her. The nurse will 
always see that there is live access to the genitals 
beneath the bedclothes, that the parts are clean. 
soiled napkin- removed, and a clean dry one tucked 
beneath the genitals. Few persons realize how very 
disagreeable it is for a physician to come in contact 
with filth and wet cloths in making a necessary exam- 
ination. If the patient lies on her side, it must he the 
left one, with her knees drawn up on the body, and 
the hips near the left edge of the bed lacing the head- 
board. The same details of cleanliness deserve atten- 
tion, and a basin of warm water, soap, and tow 
should be at hand when the examination is completed. 
The doctor usually tells the patient after it how she 



LABOR. 257 

and seldom fails to have good news, encouragement, 
and a cheery word for her. A physician does not 
deserve his title if he fails at this trying time to give 
his patient earnest sympathy, hearty encouragement, 
and his warm assurance that all is well, if he can do so 
honestly. Some, however, fail to do so, not from lack 
of knowledge, but from a failure to appreciate its value 
to the patient. 

The management, of the second stage of labor differs 
materially from that of the first. The time has come 
when real help can be given to a woman, and also when 
she realizes that progress is being made. She feels the 
advance of the child. In the first stage the pains have 
been worrying and teasing her, making her cry out, but 
the change is rapid in character soon as the child pro- 
gresses downward. The pains are now bearing down ; 
the patient instinctively holds her breath, braces her feet, 
and contracts the abdominal muscles with every pain. 
The latter is more frequent and severe, but the feeling 
of progress helps to endure them. The bearing- down 
pain is so characteristic, that experienced accoucheurs 
will at once recognize the stage of labor and estimate 
its progress as soon as they enter the room, although it 
is a well-known fact that the arrival of the doctor often 
causes temporary diminution or cessation of the pains, 
especially in the first stage of labor. The patient must 
now remain in bed and not leave it under any pretext. 
The room should be kept at a temperature of 70° Fahr. 
It often seems much warmer to the patient, as her 
muscular efforts develop increased heat in her system. 
She will seldom care to have more than a sheet or a 
blanket over her, but if not protected at the time of 



258 LABOR. 

delivery, when frequently it is necessary to expose the 
genitals, she may take cold. To guard against this, fold 
a sheet or thin blanket three feet wide and lay it 
across the bed and over the patient's chest and body. 
Have plenty of napkins at hand to mop up the dis- 
charges, and keep the patient as clean as possible. 
Never leave soiled linen or vessels in the room : such 
things should be removed at once. 

There are two ways of helping a woman in the 
second stage of labor. The first way is to sit on the 
edge Of the bed, and the patient lying on her back 
braces one knee against the shoulder of the person 
sitting there, who. in turn, takes her band- or wrists 
and pulls against her dining a pain. If. however, Bhe 
prefers to tie on her side, then she can seize one end of 
a twisted sheet which the second party hold- over the 
foot of the bed. The woman'- husband ought to be 

the one to pull at the end of the -beet or hold the 

hands. It ncnU strong muscles, and the doctor's 
strength should be reserved tor other purposes if ne 
sary, 

The second way of helping the patient i< to have 
her lie on her left side. Double up an old, thick pillow 
and place it bel ween her knees to keep them well apart. 
This takes off some of the Strain when the child i- 
born. Press with the flat of the hand during each pain 
over the lower end of the spinal column low down in 
the beginning of the second stage, but when the head 
begins to bulge out the perineum a little, always pi 
two handbreadths above the anus. 

It is not to be supposed that this book and it- direc- 
tions are to impart all the knowledge on the subject : 



LABOR. 259 

but as it sometimes happens a baby is born sooner than 
anticipated, or before the doctor can reach the house, it 
is important to have an intelligent idea of the manner 
of delivering a child and what to do before the physician 
arrives. In the first place, and above all, keep cool ; 
there will be scarcely ever any occasion for alarm. 
Eemember the process is a perfectly natural one, and 
Nature has fortunately so ordained it that, in such cases 
of quick or unexpected delivery, there is seldom any- 
thing to do but let Nature take care of herself. At 
most, a few little things may become necessary which 
any one can do. 

It is not always possible to prevent a laceration of 
the perineum, but if the following instructions are 
observed, many a tear will be prevented. If the child 
comes down so that the perineum bulges but does not 
yield, and seems rigid and dry, not allowing further 
advance of the head in spite of strong pain, then rub 
freely on it freshly melted leaf lard as hot as can be 
borne, and apply hot cloths to the perineum constantly. 
This often has a relaxing influence. Naturally, the 
head comes down during a pain and slips back after it, 
but with each pain it comes a little farther. This 
slipping back of the head is a favorable occurrence, and 
there is much less danger of a laceration if it does so, 
as the steady pressure of the head tends to make the 
tissues brittle. A great point in preventing a tear is to 
avoid as far as possible any sudden strain on the parts 
already stretched to the utmost. For this reason take 
special care to remove any support for the patient to 
brace against or to pull on. Warn her beforehand 
that when the head is low down, so that it can be 






260 LABOR. 

partly seen, that she must withstand the natural 
impulse to force out the child and take pains to open 
her mouth, cry out, or pant during a pain, and not 
contract the muscles. The parts are so numbed by 
pressure that laceration of the perineum, even when 
severe, is not felt by the patient. If the above pic- 
cautions have been faithfully observed and, notwith- 
standing them, there is a tear, it must be sewn up by 
the physician as soon as the afterbirth is delivered. 

Whether the mother lies on her back or side, the 
management of the birth of the child is the same. 
Nearly all children are born head first. The hairy scalp 
of the top of the head first conies into the world, and 
after a portion of it the size of a silver dollar is visible, 
the head is commonly horn with two or three pains 
more, and it is with these pains especially that the 
mother must remain perfectly passive, not bear down 
in the least, and take care to civ out or paid. Soon .is 
the head is horn there is often momentary cessation of 
pain. This can he improved by quickly wiping off the 

child's face, especially about the eves, with a clean 
napkin, placed previously within reach for that pur- 
pose. This hasty act requires but a few seconds, then, 
without any hesitation, as no harm can he done. pa<s 
the forefinger of the right hand up behind the child's 
neck and close to it to ascertain if the cord is around 
the neck. If so, there will be no difficulty in hooking 
the finger underneath the cord and drawing down a 
loop large enough to slip the cord from off the neck 
over the head, or, if this cannot be easily accomplished. 
loosening the coil of cord around the neck so that the 
shoulders can slip through the loop. 



LABOR. 261 

It is seldom that the cord is around the child's neck, 
and, if it happens, it is easily manipulated as just de- 
scribed. If left alone, it might interfere with the 
child's circulation enough to destroy its life before 
delivery. Both the wiping the face and feeling over 
the neck or pulling down the cord take but little 
time, much less than reading the description of it. 
Very soon another pain, i. e., contraction of the uterus, 
comes on, and the child's head turns with the face a little 
toward one of the mother's thighs. The shoulders and 
body are often born with a single pain. During the 
time the child is being expelled, always support its 
head so that it will not rest and press on the tender 
flesh of the mother, and at the same time carry it 
directly towards the mother's feet and a little forwards 
toward her abdomen. This should be done with the 
right hand, while the left hand, on the abdominal wall, 
supports and follows down the shrinking uterus, which 
will be felt hard and firm like a small cannon ball. If 
this relaxes and softens under the hand, rub it, and the 
uterus will feel harder. This hardness of the uterus 
should be maintained till the binder is applied. If the 
person who delivers the child wishes to use both hands 
for that purpose, a second individual must support the 
uterus and follow it down outside as already described. 
When the child is born there is usually a single gush of 
bloody fluid and clots collected behind the child, which 
now lies near the mother's thighs. It sometimes hap- 
pens that the bag of membrane enclosing the child has 
not been torn back from the head, so that if a thin 
membrane is seen over the child's face it must be 
immediatelv torn off or the infant will suffocate. Xo 



262 LABOR. 

possible harm can be done ; it is not adherent in any 
way more than a piece of paper would be in the same 
position. 

As a rule the baby cries as soon as it is born. If it 
does not, blow vigorously in its face or on its abdomen. 
If there seems to be mucus or phlegm in its mouth, 
hook it out with the finger, and turn it over on its 
stomach head down to let the slime and mucus run 
out of the mouth and nose. Should it not cry then, 
sprinkle a little cold water on its stomach, or take cold 
water in the month and squiri it vigorously on its 
stomach: vary this with a warm-water bath. Thi 
simple measures seldom fail; bul if then there is do 
crying or distinct breathing, hold the child up by the 
feet and spank it two or three times with light, quick 

blows on the buttocks, never On its spine. Other m« 

nres can be employed by the physician, bul are very 
rarely necessary. The mother imi>t remain perfectly 
quiet, and under no circumstances sit up or take part 
in these procedures. The cord is not to be cu1 till after 
the child has cried Loud and Btrong, or till after the 

pulsation of the cord has ceased, unless the child has 
been horn fifteen minntes. Have at hand three pit ■■ 

of tape one eighth of an inch wide and six or eighl 
inches long to tie the cord. Coarse white cotton string 
can be used as a substitute, but hemp string or thread 
of any kind will not answer the purpose. Tie the 
string around the navel cord tight in a square knot 
two inches or the length of your little finger from the 
navel: then tie the cord a second time in the same 
way four inches or twice the length of the fing 
from the navel. The third string is to be used 



LABOR. 263 

if either of the first two break. Now hold up the 
cord between the first and middle fingers on the knot 
first tied, and the thumb and third fingers on or near 
the second knot tied : this leaves the space between the 
two knots partly within the hand and protected by it, 
so that the child in kicking about cannot get a toe in 
the shears when the cord is cut. This is done by taking 
a dull pair of shears in the right hand and cutting half- 
way between the knots while the cord is held in the left 
hand. 

After the cord is cut, wipe off the cut end belonging 
to the child and watch it a moment to see if there is 
any -bleeding. If there is, apply another ligature more 
tightly to the cord so as to arrest the oozing. Kemem- 
ber that fine ligatures, like thread, cut through the 
blood-vessels of the cord and allow it to bleed. The 
baby is now to be wrapped in a warm woollen blanket 
and put in a warm place where there will not be a 
bright light in its face either from the sun or from the 
fire. 

The management of the third stage of labor is quite 
simple. By this time the placenta will have come away 
of itself in most cases, together with some blood and 
clots. It should always be preserved for the inspection 
of the physician, and afterward should be burned in a 
hot fire with the dampers open. Sometimes it is born 
at the same time as the child, and is usually expelled 
soon after. Should it be retained more than fifteen 
minutes, take hold of the cord with a dry napkin and 
draw on it a little upward and a little forward, as it 
commonly happens that the placenta, or afterbirth, is 
expelled from the uterus and lies in the vagina. In this 



264 LABOR. 

case gently pulling on the cord brings out the placenta. 
Vigorous traction on the cord is not allowable and may 
cause much harm. Let the patient cough hard or blow 
hard on the back of her hand pressed close to her 
mouth, and let the doctor squeeze the hard uterus 
by the hand on the abdomen, and it will often expel 
the placenta, in addition to rubbing and pressing od 
the abdomen over the top of the uterus. There is 
no occasion for alarm if these simple measures are 
inefficient, which is rarely ever the ease. There will 
be do harm in waiting for the physician, even if it 
be a eonplc of hours. The hand musl be kepi on the 
top of the uterus to support it. and to keep it hard by 
rubbing it a little when it softens and relaxes. Profuse, 
gushing hemorrhage continuing alter delivery, enough 
to saturate three or four napkins immediately, has been 
known to occur. Under these circumstances, at once 
remove the placenta (afterbirth), as already mentioned, 
and slap the patient's buttocks smartly two or three 
times with a wet towel, so as to redden them, if she is 
lying on her side. This is often effectual, though it 
may seem harsh treatment. If it fails, or if the patient 
lies on her back, seize a quart pitcher full of ice water, 
hold it up three or four feet above her and pour it out 
in a stream the size of your finger, so it will fall on the 
bare skin of the abdomen, just below the navel. This 
will produce a shock which will make the uterus con- 
tract and stop the hemorrhage, and then stop pouring 
the water. The patient can be wiped dry after it. and 
a flannel blanket laid over her. Half the contents of the 
pitcher is generally sufficient to stop the flow of blood. 
and there need be no hesitation about using it for fear 



LABOR. 265 

of chilling the patient; there is far less danger of any 
harm from this cause than from a profuse, gushing 
hemorrhage. The treatment is simple, but almost 
always effectual, especially if the placenta is delivered. 
"When the third stage of labor is completed and the 
afterbirth is put one side for the inspection of the 
physician, remove all the soiled linen, wash the genitals 
carefully with a one in 3,000 mercurial solution made 
according to the directions on the bottle containing the 
mercurial antiseptic tablets, or a warm three per cent 
solution of carbolic acid. If the patient is on her 
back, simply let the flow run over the parts from a 
fountain syringe and catch the fluid underneath in the 
Eureka bedpan. Pick out the blood clots, if there are 
any, from the hair ; gently dry the parts by lightly 
pressing on them a soft linen napkin or a gauze pad ; 
then apply an ordinary gauze pad or napkin. The 
next thing to do is to fold a clean, warm sheet, three 
by four feet ; lay the binder, half rolled up, across the 
middle and on the farther edge of the folded sheet, 
turn over and inwards the corners of the sheet ; then, 
when one person raises the hips of the patient, some 
one else can quickly slip beneath her the folded sheet 
and binder at the same time, so that the latter will be 
directly under the hips, with the lower edge of the 
binder a couple of inches below the private parts. The 
patient, during this time, must lie straight in bed, 
either on her side or back, and not help herself in any 
way. The folded sheet is made smooth beneath her, 
its several thicknesses protecting the bed : then the 
binder is brought over in front, the lower margin being 
a little below the genitals. Draw the lower edge as 



266 LABOR. 

snug as the patient can bear without feeling hurt by it, 
and pin with a strong safety pin. Now draw the binder 
moderately tight and smooth, so there are no wrinkles, 
and put in another safety pin a handbreadth above 
the first. In the same way draw the binder quite tight 
just above the hip bones, and insert the third pin there. 
The last and fourth pin is put in at the upper edge of 
the bandage, which is left quite loose. Never place 
any pad or napkin over the uterus and under the hand- 
age. A binder applied in this way will remain in place, 
bea comfort to the patient, and do something to preserve 
her form; though there is no such thing as forcing 
her figure to ret inn to the same shape as before child- 
bearing, and unless the binder can be put on to stay in 
place, it is better left off. Whenever the binder is 
soiled it should be renewed. As a rule, a binder re- 
quires tightening once in five or six hours, and dees 
very little good alter the tilth day, though, if loose, it 
will do no harm if the patient derives comfort from it 
and prefers to wear it. Should the pulse he over one 
hundred beats per minute, the woman should he closely 
watched tor any gush of blood or very profuse flowing 
from the uterus, in which ease the treatment is as that 
described above. A little flowing, enough to make a 
stain the size of the hand upon a napkin, in fifteen or 
twenty minutes, is quite natural, and need cause no 
alarm. It ought to diminish considerably after half an 
hour. In nearly all cases the pulse grows more slow 
after labor is completed, seldom beating more than 
seventy times a minute. After the binder is applied, 
another fresh pad or napkin is pinned close, but never 
tight, to the vulva, and the bed cleansed as thoroughly 



LABOR. 267 

as practicable. Unpin the nightdress and draw it down 
over the patient. If it has been much soiled, put another 
warm one on her. not allowing her to sit up. If she is ex- 
hausted by a difficult labor, it is far better to let her rest 
twelve hours and gain strength even in soiled linen, from 
which she can be protected by tucking in warm, dry 
towels, than to tax her little strength by further effort. 

This finishes all we can do for the patient at this 
time. The room should now be kept darkened and 
quiet, in order that she should rest and sleep. The 
further treatment of mother and child will be found in 
the chapters on ''The Care of the Newborn Child, '' and 
"The Puerperal or Lying-in Period.'' 

There remains for consideration the management of 
a case of labor when the feet or the buttocks (breech) 
of the child are born first. With the exception of the 
second stage of labor, the management of the case is 
the same as that just detailed. In the second stage, 
however, there is some difference. As soon as the feet 
or buttocks are seen, procure a physician as soon as 
possible, as the child is liable to be born dead, even with 
good care, when it is the first baby. Have the woman 
he on her back with the hips raised on a hassock, or else 
lying partly across the bed with her hips over the edge 
and her feet in chairs, the corner of a blanket wrapped 
over each limb to keep her warm. Simply support the 
child as it is born, never pull on it, but have some one 
press hard down on the uterus through the abdomen, 
over the region of the bladder, as soon as the body of 
the child is born, lifting the latter at the same time 
upwards and bending it backward over the genitals 
when onlv the head remains to be delivered. Never 



268 LABOR. 

pull on the child or draw down the feet, they will take 
care of themselves; but when the body is down far 
enough to seize the umbilical cord, draw the cord down- 
ward and backward about three inches with the finger. 
If these directions are faithfully observed, most c 
will be safely delivered. Of course there are many 
things a physician can do which others cannot from 
lack of training and anatomical knowledge. It is 
obvious that further instructions, applying only to very 
exceptional cases, would be out of place and misleading. 
My reader may be surprised that there has been no 
reference to anaesthetics, those wonderful agents which 
give so much relief from pain in childbirth. While 
many agents are used, in ordinary practice either chlo- 
roform or ether, or a mixture of the two, is the com- 
mon agent employed Wm relief from pain. The former 
will ever be associated with the name of Sir James 
Simpson, who introduced it in spite of vigorous opposi- 
tion at the time by both clergymen and physicians. It 
i^ more easily taken and has a more rapid effect than 
ether, which is equally safe but nol s<> pleasant t<» take; 

neither should ever be employed in domestic practice. Or 
by any one but a physician. Both commonly prolong 
labor by Lessening the severity of uterine and voluntary 
muscular contraction. Women who are predisposed to 

hemorrhage after childbirth — an exceedingly rare con- 
dition — ought not to take either of them. In an 
extensive experience with various anaesthetics for labor. 
I prefer, for ordinary cases, what is known as the A. C. E. 
mixture, one part of chloroform, two of alcohol, and 
three parts of ether. This has answered the purp 
in every way, and I have never seen any harm from it. 



LABOR. 269 

By giving it in a suitable manner in the latter part of 
the second stage of labor, my patients have felt very 
little pain, and yet have retained consciousness all the 
time. The method is simple, merely sprinkling a few- 
drops on a handkerchief and smelling vigorously of it 
the moment the pain is felt approaching, and removing 
the handkerchief as soon as the pain diminishes. 

An anaesthetic must not be given till near the close 
of the second stage of labor. Not only is labor prolonged 
by it, but the anaesthetic will be conveyed to the child, 
which may not cry so quickly after it is born. I prefer 
ether for all cases requiring an operation. Chloroform is 
more likely to be followed by hemorrhage than ether. 



CHAPTER VI. 
THE PUERPERAL OR LYING-IN PERIOD. 

The diet of a Lying-in woman has much to do with a 
good recovery. Formerly the diel was much restricted 
for a considerable period, but modem medicine has ex- 
posed the fallacy of such treatment and shown the 
importance of giving the mother as much simple, nour- 
ishing food as she can digest, and in this way huild 
her up and restore strength and vigor. A severe 
Labor exhausts the entire organism; both the muscular 
and nervous systems are weakened. The stomach and 
digestive functions are no exceptions to the rule, hence 
the necessity to give easily digested food at short inter- 
vals to avoid overtaxing or overloading the stomach. As 
soon as nourishment reaches and supplies the innu- 
merable cells making up the organism, the Latter is 
strengthened, and correspondingly can perform all its 
functions to hotter advantage. The stomach can digest 
more hearty food, which in turn can be supplied in 
greater abundance to the system, which is not only 
replenished but is enabled to carry on the processes of 
growth and the removal of waste or dead matter within 
itself. This is the principle to follow in prescribing the 
diet for the sick woman. We can hardly call her sick 
under ordinary circumstances, as the term "sick" im- 
plies disease. In this sense she is not a sick, hut rather 
a well woman in a prostrated condition. While this is 



THE PUERPERAL OR LYING-IN PERIOD. 271 

really of a physiological, i. e. , natural character, it must 
never be forgotten that slight imprudence easily tips 
the balance, and from being a well woman she easily 
becomes very dangerously sick. 

In the first twenty -four hours after delivery hot 
water or toast water to drink, all she cares for, milk 
and thin oatmeal gruel, very thoroughly cooked, can 
be taken, half a teacupful at a time, once in two 
hours. Never disturb her when sleeping quietly : wait 
for her to wake, and then give the milk or gruel. A 
feeding cup or a bent glass tube is convenient for this 
purpose, but not necessary. 

The second day after childbirth the amount of milk 
and gruel can be increased if it has agreed previously 
with her. Very weak tea and dry toast, Mellin's food, 
Imperial granum, a white of egg beaten up with an 
equal amount of water or malted milk, can be used 
equally well. 

The third day commonly marks the time when the 
milk comes into the breasts, which puff up, and rushing 
sensations in them or little fine pains are often experi- 
enced. This is sometimes attended by chilliness and a 
little fever, called milk fever, which disappears when 
the flow of milk is established. Milk toast can be added 
to the previous dietary. 

The fourth day is usually a much more comfortable 
one for the patient. All signs of fever probably will 
have subsided then, and, in addition to the articles of 
food mentioned, she can take to advantage Eeed & 
Carnick's beef peptonoids, three tablespoonfuls, in the 
course of twenty-four hours. This is not always at 
hand, and mutton broth with a little rice in it, or 



"11-1 THE PUERPERAL OR LYING-IN PERIOD. 

chicken soup made from a fowl not less than one year 
old can be substituted with excellent advantage. The 
fat should be removed from the broth or soup by allow- 
ing it to cool and then reheating just before giving 
it. The fowl is preferable to chicken for making broth, 
as the flesh is more mature and supplies more nourish- 
ment to the broth. As the preparation of this sou]) 
sometimes causes much trouble at a time when the 
mistress of the house is unable to give the matter any 
thought, and also when servants often cause trouble or 
are unable to prepare it' properly, T have recommended 
Biardot's Francb-American chicken broth or soup, as 
prepared for invalids, and sealed in glass jars ; the 
broth is a little more delicate and not quite as strong 
the soup. It has always given much satisfaction to 
both my patients and myself. The pulp of a few sweel 
grapes is also allowable at this time. As the patient 
can eat more in quantity without discomfort, it i- not 
necessary to eal as often : once in three or four hours 
will be sufficient after this day. 

The fifth da// after delivery, if all goes well, a 
woman can, in addition to the foregoing, eat a little 
from the breast of a bird, or chew a mutton chop or 
a piece of steak, swallowing only the juice. If sin 
should happen to swallow some of the meat fibres it 
would do no harm ; raw oysters, stewed prunes or figs, 
the pulp of a baked sweet apple, or a part of a very 
ripe peach can also be eaten as fruit. Sour fruit of any 
kind must not be eaten on account of affecting the 
milk in the breasts. After the fifth day moat, mealy 
baked potatoes, eggs in various forms, and egg-nog with 
sherry, if need is felt for a mild stimulant, are all 



THE PUERPERAL OR LYING-IN PERIOD. 273 

allowable. In beginning any new article of food abont 
which there is any uncertainty, use only a small quan- 
tity at a time. Do not try to eat articles of food at 
this time which are known to commonly disagree with 
the stomach. Beans, cabbage, or onions, and sometimes 
potatoes must not be eaten, as they affect the milk, 
and make the nursing baby subject to wind colic. Acid 
food or drink also affects the milk, and must not be 
taken. 

There is far more than people think in serving food 
so as to tempt the appetite. This is particularly true 
under these circumstances, when the exhausted woman 
with, perhaps, a weak stomach at best, is offered food. 
Let the odors of the kitchen permeate the chamber ; 
bring on at one time a comparatively large quantity of 
food, even if ever so well and delicately cooked ; serve 
it in common dishes ; omit the little luxury of a fresh, 
clean tray-cloth and napkins ; allow the attendant to 
approach with unclean hands or untidy dress, tasting, 
perhaps, to see if the broth is not too hot, and using 
the spoon provided for the patient, — and there are few 
women who are not forced to turn away in disgust, or 
lose the little appetite with which, under proper man- 
agement, the meal might have been eaten with genuine 
relish. 

Strive to adopt the following suggestions : keep all 
kitchen and cooking odors from the chamber. Do not 
tell the articles of food before it is brought in. . Serve 
it in small quantities, with as pretty china or dishes as 
circumstances permit, and always with fresh, clean 
napkins, tray -cloth, and scrupulous neatness of the 
attendant. Bring it in fresh, hot, and appetizing, and 



27-t THE PUERPERAL OR LYING-IN PERIOD. 

then never blow the broth to cool it, nor taste to see 
if it is properly seasoned. The patient can do this quite 
as well for herself, and with more relish for the food. 
Let the food be fresh, rather than salt, as the latter can 
be readily added to suit her taste. There is a real 
knack in arranging a tray daintily, perhaps adding 
sprig of green or a flower, so as to tempt a delicate 
appetite, and always remove the tray at once when the 
meal is finished. 

Absolute rest and the utmost quiet should prevail. 
Darken the room to favor sleep. Watch closely for 
any draught o\' air which may blow over the bed. I 
have found the following ventilation very efficient and 
satisfactory : Take a piece of one half inch board twelve 

inches wide, and cut it off just long enough to lit tight 

in the frame of the window, its lower edge resting on 

the sill ; a strip of felt can he tacked on the end- to 

prevent scratching the woodwork. This board should 
he an inch or more in front of the sash : then raising 
or lowering the sash regulates the amount of air in the 

room, which must enter in an up and down current 
about the window, and cannot blow directly in the room 
as long as the lower edge <^t' the sash is below the upper 
edge of the board. All visitors, even members of the fam- 
ily, must be excluded from the room : only the doctor, 
nurse, and the husband for a few minutes, should be al- 
lowed to enter. If the baby cries much it should be kept 
in another room, so as not to disturb the much-needed 
rest of the mother. Under no circumstance- is the lying- 
in woman to rise from the bed before the proper time, 
or even to sit up in bed. In both there is danger of dis- 
lodging a blood clot, which might enter the circulation 






THE PUERPERAL OR LYING-IN PERIOD. 275 

and cause instant death, besides the risk of catching 
cold, which too often is the cause of a serious illness. 
The chill just mentioned must not be confounded with 
the sensation of cold within a few minutes after the 
child is bom, which is quite natural, due. partly, to 
loss of animal heat from within by the birth of the 
infant, and partly by the cooling of the skin by evapo- 
ration of the perspiration, and heat not being produced 
to the previous extent by muscular energy. Except as 
she needs a change, it is better for a woman to he well 
over on either side than on her back. 

Take pains to keep the wrinkles out of the bed as 
well as crumbs of food, which chafe the skin and disturb 
the comfort of the lying-in woman. 

The urine is more abundant after labor, but, as the 
impulse to pass it is very feeble, never wait till the 
woman expresses a desire to pass water, but invariably 
make it a rule to pass urine once in six hours : neglect 
to do so may result in inflammation of the bladder. 
The sound of running water or hot. dry flannels laid 
over the bladder will sometimes aid micturition. 
Should these measures fail, the doctor will be obliged to 
introduce the catheter, and before this is done the 
external genitals must be cleansed with great care, 
especially about the water passage between the labia, 
or lips. 

Constipation is of common occurrence during the 

latter part of pregnancy and in the lying-in period. If 

* 

the bowels have not moved on the third day after 
delivery. I am accustomed to order an enema. First, a 
small injection of a tablespoonful of oil, an equal 
amount of glycerine, and rather less than a pint of 



276 THE PUERPERAL OR LYING-IN PERIOD. 

water stirred well together and injected very slowly 
into the bowel. This enema softens the fecal matter 
and is really preparatory for a second large one after a 
few hours, of lukewarm water, which will be unneces- 
sary if the first enema causes a tree movement. 
Freely eating of fruit, avoiding that which is very sour. 
is excellent to promote evacuations from the bowels.' 
Collinsonia**, a dose once iii four hours, is a good 
remedy for const ipat ion at this time. 

Piles are a not uncommon and distressing accom- 
paniment of severe and protracted constipation. Secur- 
ing five evacuations from the bowels are essential to 
cure. Equal parts of Hamamelis and Aesculus hip. 
cerate make an excellent ointment to be applied freely 
night and morning. Aesculus hip.* x , Aloes**, and 

Nux ro)i/.' )x are the important remedies. Begin with 
the tiisl and take ;i dose once in three hours. If not 
better in four days, take the second remedy in the same 
way, more especially if there is a sense of bearing down 
in the rectum, bleeding, and the piles protrude like ;i 
bunch of grapes. Nux vom. u and Collinsonia** are 
also most useful remedies for piles, and are to he 
taken, like the other remedies, once in four horn-. 

Cleanliness is of the utmost importance in caring 
for a lying-in woman, and special attention should he 
given to every detail about the person and everything 
coining in contact with her. The skin acts more freely 
than usual, and the profuse perspiration is often very 
uncomfortable. A warm sponge hath can be easily 
given two or three times a day. according to the 
amount of perspiration. Take pains to have the sponge 
or cloth squeezed dry enough to avoid dripping and 



THE PUERPERAL OR LYING-IN PERIOD. 1 } S i 

wetting the bed or clothing. Sponge a small place at 
a time, and dry it at once with a towel. A little aqua 
ammonia in the water makes it more refreshing and 
helps to clean the skin. Alcohol, bay rum, or sea salt 
can be added to the water instead of the ammonia, if 
the patient prefers, but the latter is more cleansing. 

After the morning and evening bath has been given, 
I advise a small vaginal douche, though the opinion of 
the attending physician ought to be asked first. Buy 
an ounce of the crystals of permanganate of potash. A 
very few of these crystals mixed in two quarts of luke- 
warm water will be sufficient to color it a light red, 
i. <?.. wine red color. If the labor has been difficult and 
the parts are much bruised or lacerated, add a table - 
spoonful of the aqueous extract of calendula to the two 
quarts of water colored with the permanganate of 
potash as mentioned above. Stir well and use it for a 
vaginal douche, taking care to move the nozzle of the 
syringe freely about in the vagina so that the vagina 
will be washed out thoroughly. This douche should 
be given twice a day for the first five days, and longer 
if the vaginal discharge is profuse (four napkins a day 
well soiled), or if it smells badly. When the lochia 
becomes scanty, a douche in the morning is sufficient 
and should be continued till the discharge ceases. 

A fountain syringe is the best, taking special care 
there is no hole in the centre of the end of the nozzle 
and to let the fluid run through a little to expel the air 
before introducing it within the vagina. 

The external genitals always must be washed before 
giving the douche. A good way to do this is to allow 
the tepid water to run over them while the patient is 






278 THE PUERPERAL OR LYING-IN PERIOD. 

on a bedpan. The Eureka pan is the best for this 
purpose and for this form of vaginal douche. Warm it 
before using and empty it directly afterwards. Make 
it a rule always to scald it with hot, fresh permanganate 
of potash solution, and wipe it dry with as much care 
as if it were to he put away for a year. Remember, 
that attention to all these details is of immense value 
to the patient and docs much to aid her recovery. 

After the douche, if there has been any laceration 
of the perineum or abrasion of the skin, as is often the 
case, F have found the use of calendula cerate rubbed 
gently and freely on the parts and within the orifice, 
smearing it thickly over any injury, is of greal service 
in promoting healing, and preventing the lochia or 
other discharges from irritating or poisoning the 
wounded places. If the patient is not too tired after 
these manipulations, rubbing her all over with the Hat 
of the bare hand from the hands or feel toward the body 
is very refreshing; some ladies like to have the hand 
of the attendant use a little alcohol in rubbing, which 
produces a cooling sensation and will do no harm. Avoid 
much friction on sore places and never rub a milk Leg 

In washing the patient*- \'.\<r and hands, the nurse 
must see that her own person is clean and tidy, as well 
as the water, sponges, soap, and towels, and take care 
not to fill the eyes with soapsuds. After the hath. 
brush out the patient's hair nicely and do it up in two 
braids, then the hair on each side of the head can he 
brushed and braided without raising the head. A towel 
laid over the pillow at this time adds to the neatness of 
the bed. 

The napkins or pads must be changed when 



THE PUERPERAL OR LYING-IN PERIOD. 279 

soiled much, and always be fresh night and morning. 
They need to be pinned on snug, but not tight, as the 
flow would then be obstructed. The nurse must exam- 
ine the napkin every hour for six hours after delivery 
to see that the patient is not flowing too fast. If she 
finds that the stain is the size of her hand within ten 
minutes after the napkin is applied, the flow is too pro- 
fuse and the doctor must be notified. Always remem- 
ber to tell him the number of napkins soiled in twenty- 
four hours, if much or little ; if there has been a sudden 
cessation of the discharge ; if it is very offensive ; if 
the patient has had a chill or fever, sweat very profusely, 
or been much exhausted . Never allow soiled linen to 
remain in the room, or filth of any kind. Burn the 
pads, and at once remove and scald any utensils which 
have been used. 

Tlie lochia are the vaginal discharges after labor. 
During the first three days they are quite red, being 
nearly pure blood. After the third day the discharge 
gradually loses color ; after the fifth or sixth day it has 
a creamy character, and after the tenth day becomes 
a greenish watery discharge. 

There is only one really good rule to go by in allow- 
ing the lying-in woman to sit up for the first time. No 
definite day can be given, except that very few women 
ever should be allowed to leave the bed before the tenth 
day. The fact that some women do so is no reason 
that it is best for them. The correct rule is this : not 
to sit up before the uterus has shrunk so that it is 
low down and within the small pelvis, and to return 
always to bed for a couple of days if sitting up causes 
a reddish flow from the vagina. 



280 THE PUERPERAL OR LYING-IN PERIOD. 

Anatomically speaking, the uterus returns to its 
ordinary size in six weeks, always remaining a little 
larger than in the virgin state. Practically, however, 
it requires three months of good care before a woman 
is herself again, even with the best of care and careful 
nursing. A husband does a great wrong to his wife if 
he subjects her to coitus for at least six months after 
the child is born. 

The idea is prevalent that a nursing woman cannot 
conceive, probably because the menses do not often 
return for six or eight months, or perhaps a Longer 
period. If she does not nurse her child, the monthly 
flow usually appeals mi the third month. The popular 
opinion mentioned above Leads many women to nurse 

their children too Long tor the good of cither, in the 
hopeof avoiding a dreaded conception, and on the other 
hand marital relations are sometimes carried to an 
extenl seriously endangering health, at the very time 
when a woman's sexual organs require rest t<> recuper- 
ate. It may be well to state here that nursing od 
no immunity from conception, as many a woman has 
learned to her 801TOW. Could the secret and unwritten 
history of the life of many a suffering woman he known, 
it would be a revelation of the cause of her trouble, 
which often remains a secrel known only t<> herself and 
unsuspected even by her husband. 

After pains are sometimes very distressing, and are 
caused by the contractions of the uterus to expel blood 
clots collecting within it, consequently these pains 
resemble labor pains on a small scale. They seldom 
occur after the birth of the first child and are very 
common after subsequent labors. The pains occur at 






THE PUERPERAL OR LYING-IN PERIOD. 281 

intervals, commencing soon after the child is born, and 
usually cease on the third or fourth day. Pain in the 
abdomen, beginning for the first time on the second or 
third day, is due always to some other cause, demanding 
the careful attention of the physician. 

Therapeutics. 

Arnica 8 *. — A dose once in three hours is an excel- 
lent remedy to take after delivery. It modifies the 
after pains and hastens recovery from the soreness inci- 
dent to labor. Severe after pains returning when the 
child nurses. 

Secede eor. 3x . — A dose once in two hours, if the 
after pains are long and severe like labor pains, and the 
patient does not like to be covered, although she may 
be cold. 

Cimicifuga rae. 2 *. — Once in two hours, after pains 
are felt, especially in the groins, if the patient is very 
sensitive and also has nausea and vomiting. 

Chamomilla Sx . — A dose once in two hours, if the 
after pains fret and annoy the patient, making her very 
cross. Under such circumstances the pains are apt to 
be sharp and pinching in character. 

It is impossible to remember all the little details 
which may occur and report them to the physician. 
For this reason I am accustomed to direct the 
nurse to take a sheet of foolscap, or some large piece 
of paper, and draw a few parallel lines down on it 
and write at the top the date and above each column 
the points to be mentioned beneath it. The fol- 
lowing will give an idea of such a sheet and a partial 
record : — 



282 



THE PUERPERAL OR LYING-IN PERIOD. 



MAY 15, L890. 



TIME. 


PULSE. 


TEMP. 


1 OOD. 


MED. 


i kim:. 


BLEEP. 


NUBfi'G 


REMARKS. 








Kind 




Ft'cr-. 






Had ;i comfortable 








and 










night, but complains 








Ain't. 




Kapk'8. 






.ii some pains In the 
bowels. 


9 A.M. 


75 




1 CUJI Of 

gruel. 






1 hour. 




Peels better Blnce 


K> A.M. 








X 








having :i free evacu- 
ation from tia- bow- 


11 A.M. 






': PUD 

of milk. 




Ch.V K "l 




30 min- 


els. 










Napk's. 




utes. 




12 M. 








X 


Bowels 

lllc>\ C(|. 


% hour. 







Iii tliis way the entile record of a id be kept, 

and nothing escape attention which mighl benefit the 
patient. 

The breasts often need more attention than is given 
them, till, perhaps, it is too late, and much needless suf- 
fering is the result. The preliminary care given them, 
as described in a previous chapter (page 207 . is suffi- 
cient till after the milk has appeared in the breasts and 
the child nurses more vigorously and more often. The 
proportion of tannin to one ounce of brandy or gly< 
me is twenty grains. Have the druggist prepare it in a 
bottle, with a camel's-hair pencil through the cork, just 
like collodion. Apply it with the brush and let it dry 
on and about the nipple. It is much neater than using 
the lingers. The secretions are apt to soften the super- 
ficial cells on the skin, which in turn is sucked off, so to 
speak, by the child, and sore nipples result. Nbonehas 
any idea of the pain caused by an apparently minute 
fissure or abrasion, except those who have suffered from 
it. Never allow a child to nurse intermittently lor a 
long time and go to sleep with it in the mouth. This 
softens the nipple and is a common cause of abraded or 



THE PUERPERAL OR LYING-IN PERIOD. 283 

fissured nipples. These, in turn, are by far the most 
common cause of abscess of the breast, known in com- 
mon parlance as "broken breast." 

Many women fail to appreciate the importance of 
observing strict regularity in nursing infants from the 
very beginning. The child should be put to the breast 
every four hours after delivery till the milk comes. It 
is true, the child obtains but very little, not much more 
than the meconium, the creamy-looking fluid which 
collects during pregnancy. This has a slight purgative 
action, and is all the child's system requires. This 
nursing, however, is very beneficial to the mother. It 
promotes good contraction of the uterus, acts as a 
preventive against hemorrhage and also after pains, 
though sometimes it causes quite painful contractions of 
the uterus. This is a good sign and far from the evil a 
woman is apt to ascribe to the nursing. After the milk 
has come, nurse the infant regularly every two hours in 
the daytime and four at night. Omit the hours between 
twelve and four; this period can be gradually lengthened 
so as to give a fairly good night's rest to mother and 
child. An hour in between is bad, as the infant be- 
comes accustomed to it, will not give it up, and for 
months the night's rest is disturbed, which would not 
be the case if a right beginning had been made. As 
the child thrives and grows older the intervals of nurs- 
ing can be prolonged, but very regular hours ought to 
be observed invariably from the very first nursing. A 
healthy infant nursing vigorously will empty a breast 
in fifteen minutes, and should then be removed. Both 
before and after nursing the nipple should be washed 
in clean, lukewarm water and carefully dried. Short 



284 THE PUERPERAL OR LYING-IN PERIOD. 

nipples can be drawn out with an ordinary clean clay 
pipe, or by heating an empty bottle and applying the 
mouth of it over the nipple, as the bottle cools the 
nipple is drawn up in the neck. Care must be exercised 
in removing the bottle so as not to cause pain. 

Cracked, abraded, sore nipples can only be healed 
with certainty in one way. and in very many cases only 
by this way, /. e., the cessation of nursing. This, how- 
ever, is often very undesirable, and the welfare of the baby 
makes it all important to heal them if we can without 
interrupting nursing. The latter act not only softens 
the skin but tears open the cracks and sore places as fast 
as they can heal. A nipple shield willprotecl the skin 
to sonic extent, and 1 have found Needham's nipple 
shield the most serviceable of any. The shield musl be 
carefully cleaned each time after using, and kepi in cold 
water. Wei the inner surf ace before applying it, and 
draw the milk into the nipple before the child takes it. 
Rubber is liable to have a little taste very objectionable 
to some infants. If the rubber is very thoroughly washed 
when first bought, vigorously rubbed in some spirit 
and again washed, infants are less likely to object to it. 

Painting the nipple frequently with the white of 
an egg and allowing it to dry is a good remedy Cor 
mild cases. For very sore nipples a cloth wet with 
Goulard's extract and kept on the nipple between the 
intervals of nursing is an excellent application, but 
thorough washing of the nipple is very necessary before 
each nursing. Calendula extract is also a good appli- 
cation. SilicecP*, a powder, once in four hours, is a 
good remedy to take internally. Other applications 
and medicines should be left with the physician. 



THE PUERPERAL OR LYING-IN PERIOD. 285 

Caked breast, as it is commonly termed, is due to 
the collection of a surplus of milk in some portion of 
the breast. While this is generally due to the milk not 
being drawn out, do not imagine the case can be cured 
by that pernicious instrument, the breast pump, which 
is often responsible for an abscess developing later. It 
uses too much force, and milder treatment must be em- 
ployed if the breast is very much distended and painful. 
The hot- water bottle can be tried as mentioned above, or 
the nurse or husband can draw out the milk with their 
mouth. It is not necessary to draw out all there is, 
only enough to relieve the tension. Caking of the 
breast expresses the condition as it feels when the hand 
is passed over it. The entire breast may feel hard, or 
only in places which are sore and tender. These can be 
manipulated to advantage by any one with a soft hand 
and a gentle touch, using either camphorated or sweet 
oil. Support the breast gently with one hand, while the 
flat surface of the other hand strokes the breast gently 
from the circumference round toward the nipple. This 
should be gentle enough to avoid all actual pain. It 
stimulates the circulation of both the milk and blood, 
and after half or three quarters of an hour the 
cake will be found softer or perhaps cannot be felt. 
This manipulation should be repeated four or five times 
a day, but with great care not to excite inflammation. 

Another way to relieve caking of the breast, which 
is to be employed with other treatment, is to prevent 
the production of milk as much as possible. This is 
best accomplished by drinking very little fluid, eating 
toast and a little gruel instead of milk, avoiding all 
preparations of malt or malt liquors, and when milk is 



286 THE PUERPERAL OR LYING-IN PERIOD. 

drawn from the breasts, only taking away enough to 
relieve painful tension, as emptying the breast stimu- 
lates further secretion of milk. Supporting the breasts 
in slings and packing cotton wool around them often 
bring a sense of relief. 

These measures are commonly quite sufficient, to- 
gether with the remedies mentioned below. Some- 
times it is absolutely necessary to dry up the milk 
entirely. Then, in addition to the above measures, 
mix nearly equal parts of pure, genuine beeswax 
(not the refined) and olive oil, the Latter being 
little in ex< These readily mix on heating, and 

form a thick ointment. Spread a thick layer of it on a 
round piece Of linen six inches in diameter with a little 
hole in the centre for the nipple. Apply this to both 
breasts and let it remain for twenty-four or forty-eighl 
hours or even Longer, according to the effed desired. 
It can be changed once in twelve hours, and the breasl 

wiped dry from the perspiration which will accumulate. 
It' entirely drying up the milk is desired, the contin- 
uance of this treatment will surely accomplish the 
object ; but if, as in abraded nipples, a small abscess, or 
an excessive production of milk, only a diminution of 
the secretion is aimed at, then the application of this 
plaster for thirty-six or forty-eight hours is usually 
sufficient. I learned the value of this treatment a- one 
of the medical officers in the famous Rotunda Hospital 
in Dublin, and for some years since that time I 
have tried it without fail in a very large number 
of cases. When the breast is full and painfully dis- 
tended, either from an excess of milk, caking, or 
inflammation, it should be supported by a large silk 



THE PUERPERAL OR LYING-IN PERIOD. 287 

handkerchief with the corners tied over the back of 
the neck. 

Therapeutics. 

WBryonia is an invaluable remedy for simple 
caking of the breasts. I seldom have any use for 
another medicine in connection with the above treat- 
ment. Give a dose of the third decimal preparation 
once in two hours. 

| Phytolacca is only inferior to Bryonia, and to be 
used in the same way in the second decimal dilution. 

Belladonna*** once in an hour and a half, is prefera- 
ble if there are, in addition to the caking, sore lumps in 
the breast which ache and throb and have a little blush 
of red on the surface ; such a state points to the 
commencement of an abscess. 

Broken breast or abscess of the breast is an exces- 
sively painful affection. It is most commonly due to 
an infection originating in a fissured or cracked nipple, 
but is also caused by using the breast pump, by taking 
cold, and by endeavoring to force the swollen breasts 
into tight corsets. It may develop at any time, but is 
most frequent at the latter part of the second week or 
at the beginning of the third. Some lump in the breast 
becomes painful, reddens, protrudes, and finally opens, 
discharging matter. These should be treated by a phy- 
sician. In severe cases it is necessary to wean the 
child ; even nursing from the well breast will irritate the 
diseased one. The treatment given for a caked breast 
as detailed above is also the best for this affection in its 
early stages. If, in spite of this, the redness and pain 
increase, then give a dose of Merciirins vivus 3 * every 
two hours. If this fails to create any improvement in 



288 THE PUERPERAL OR LYING-IN PERIOD. 

twenty-four hours, and the pain increases with throb- 
bing, then, and not till then, apply a thick hot liDseed 
meal poultice, changed as often as it becomes cool, and 
give Hepar sulphur** every two hours. This will rap- 
idly bring the abscess to a head and make it break, if 
the physician does not think it advisable to open it. 
As soon as it has discharged; stop entirely the poultice 
and the Hepar sulphur, and apply a piece of oiled linen 
or soft thin flannel ; then give a dose of Mercurius 
rir. :;x once in four hours. If the abscess is slow in 
healing, wash out the cavity daily with a wine red 
solution of permanganate of potash, and take care to 
keep the abscess open on the surf ace by bits of boiled 
white embroidery silk tucked in the opening till the 
abscess has healed from the bottom. Meanwhile, g 
a dose of SiliceaP* and of Phosphorus** every two boms 
alternately. 

While the attending physician will be familiar with 
other modes of treatment which may be advisable in 

exceptional cases. I am convinced that tin's one will 

give by far the best results for the majority of cases 
and especially for those in dome-tic practice. 

Sometimes the milk is very scanty, too little to 
supply the child with nourishment. A liberal diet and 
the use of malt liquors may increase the secretion of 
milk, but it is often of poor quality and. in the majority 
of cases, attempts to increase the quantity and quality 
of the milk are failures. The quantity may be 
increased, but the quality will be poor as shown by a 
chemical analysis, and not enough gain in weight. 
chapter on * k The Care of the New-Born Child. ") A d< »« i 
of Sulphur** once in four hours is sometimes helpful. 



THE PUERPERAL OR LYING-IN PERIOD. 289 

If, after a week, the amount of secretion has not 
increased, try Agnus vastus 3 *, a dose once in four 
hours. Further treatment, or the application of 
electricity, which is seldom of any use, should be left to 
the medical attendant. 

Milk leg. also known among medical men as 
phlegmasia alba dolens, has no connection with the 
milk whatever, though old-time fallacies have given it 
that name. This disease seldom begins before the 
second or third week after delivery, and is commonly 
preceded by neuralgic pain in one or both limbs as they 
are likely to be affected. If the disease begins in one 
limb, it often goes to the other limb as the first one 
gets well. This affection is characterized by extreme 
tense, white swelling of the entire limb, which feels to 
the patient like a wooden leg. The disease is a very 
slow one, always requiring some weeks before it is safe 
to use the limb, from the danger of recurrence. It is 
not dangerous to life, but the leg is often weak for 
months and, in many cases, never fully regains its 
former condition. Patience, and rest with the limb in 
an elevated position, are the two great remedies. One 
thing in particular must be always carefully avoided : 
never rub or massage the limb. Pulsatilla 3 * and 
Hamamelis' 2 * are the chief remedies, a dose four times 
a day, using each remedy four days at a time. 

Puerperal fever, childbed fever, septicaemia, and 
blood poisoning are only different names for essentially 
the same disorder. It is possible for the fever to begin 
at any time during the lying-in period, but with very 
few exceptions it commences with a severe chill forty 
eight hours after labor, followed by fever which during 



290 THE PUERPERAL OR LYING-IN PERIOD. 

its course is usually worse at night and better in the 
morning. Headache is not uncommon, otherwise pain 
is seldom experienced. Profuse perspiration, prostra- 
tion, and apathy are common symptoms. The milk 
dries up, the lochial flow becomes offensive and not 
infrequently ceases. Delirium is sometimes present in 
severe cases. Slight chills about the third day occur 
often when the milk flows into the breasts, and a little 
fever may be present from slight absorption of the 
discharges in torn places in the mucous membrane, but 
its mild and transitory character readily distinguishes 
it from the serious disease under consideration. 

Childbed fever i^ often fatal, and if a woman recov- 
ers from it. sterility or some serious disease of the 
pelvic organs not uncommonly follows as it- direct 

result. 

The canst' of tins disease is invariably infection, i. e., 
inoculation of patient from some contagious dise 
erysipelas, pus. or decaying matter. It may he from 
physician, uurse, clothing, instruments, etc. A patient 

does not inoculate herself, and the disease is not the 
result of taking cold as is often maintained and appar- 
ently confirmed by the fact of the chill which was 
really due to the poisoning of the system. It lias been 
repeatedly proven that the most exacting cleanlii 
of everybody and of everything;- in contact with the 
patient will certainly prevent childbed \^\rv. 

The disease is far too serious ior domestic treatment. 
Vaginal douches twice a day. an abundance of nourish- 
ment and stimulants for some cases, are of great 
importance. 



CHAPTER VII. 
THE CARE OF THE NEW-BORN CHILD. 

A child which has been carried the full period of 
pregnancy weighs on the average seven and a quarter 
pounds, and is eighteen inches long ; the finger nails 
are well formed and project a little over the tips of the 
fingers ; the body appears plump, pinkish, well nour- 
ished, and the child has a loud, vigorous cry. 

If labor has been very difficult, the head is often 
elongated and rarely may show depressions or marks 
of compression from contraction of the pelvis or instru- 
ments : in the latter case, paralysis of some of the 
facial muscles may result from compression of some 
nerve trunk. The head very often has a soft swelling 
on top, looking as if it had been bumped. These 
several conditions may appear quite alarming at first 
to anxious parents, but a very marked improvement 
will be observed on the second or third day, and in a 
week all signs of them usually will have disappeared. 

After the toilet of the parturient woman has been 
completed, the baby, which has been kicking in a 
blanket on some easy-chair or other warm safe place, 
deserves our attention. Its body has on it more or 
less of a thick, white, greasy looking substance, more 
abundant in the groins and on the back. Soap and 
water will remove it only with some difficulty and 
considerable rubbing ; in fact, requiring too much 



292 THE CARE OF THE NEW-BORN CHILD. 

scrubbing for the delicate skin of a new-born child. 
Soap is too irritating, and the use of a water bath too 
often causes snuffles, i. e., a cold in the head. How 
shall the baby be cleaned ? The simplest and best way 
is to anoint the baby freely with warm sweet oil or 
fresh lard and rub it in thoroughly but lightly where the 
greasy substance, called the vernix caseosa, is mosl 
abundant. After tins wrap the baby up in a warm 
flannel blanket and gently rub the body with the 
flannel. This will clean the skin very nicely. If a 
little of the greasy substance happens to be left, it will 
dry up and scale oft' without any barm, and the skin 
mighl he injured by vigorous attempts to clean it. 
Lukewarm water and sponge or linen cloth can 

be used tor the lace of the child, taking pains to 
separate the eyelids and to allow pure. Lukewarm 
water t<> trickle over the eyes and cleanse them. 
This washing of the eyes is very important and should 
he performed carefully, as secretions are sometimes 
retained in them which cause acute inflammation and 
Loss of sight. Any sticking of the eyelids, secretion, 
and especially swelling of them, demands the imme- 
diate attention of the physician. It is hardly necessary 
testate that soapsuds must never he allowed to enter 
the baby's eyes, as sometimes happens from careless 
bathing. 

A baby should be bathed twice a day in summer and 
once a day in winter. Following a certain method in 
bathing a baby is of considerable importance. It adds 
much to the comfort of the baby and take- Less time. 
Many a baby cries in his bath because the room or tin 
water is too cool, or because the nurse is too Ion-- about 



THE CARE OF THE XEW-BORX CHILD. 293 

it and he becomes chilly. A baby often cries at night 
because it is not warm enough. The room during the 
bath should be warm, 75° to 80° F., and the windows 
or doors admitting draughts of air must be closed. 
Ordinarily the temperature should be 6$° F., and not 
vary more than three degrees above or below it night 
or day for some months. The temperature of the 
water should be 00° F. in the tub measured by the 
thermometer every time just before the baby is placed 
in it. Be sure that everything is at hand before the 
baby is disturbed ; lay out the little clothes aired, 
warmed, and arranged together so that the infant can 
be easily and quickly dressed in fresh clean clothing ; 
nor should the powder and puff be forgotten. Use very 
little soap on a baby's skin and only old, white castile 
soap. A child bathed once or twice every day is uot 
soiled enough to use soap except at rare intervals. Do 
not have the infant's eyes face the sunlight or the glare 
of an open fire. Finally, when all is ready, the foot 
bath-tub and water in front of you, the toilet articles, 
a soft flannel blanket and a soft linen towel to your 
right, the clothing to your left ready to dress the baby 
without delay, and having selected a low chair to sit in, 
you can take baby on your lap, undress him quickly, 
lay him at once on his back in the bath-tub. supporting 
his head with your left hand so as to keep the face out 
of water. Splash and rub the water over the chest and 
abdomen, then over the arms and hands, and lastly 
over the legs and feet ; give a little extra attention to 
washing the flexures of the thighs. The next step is 
to turn the baby over so as to support its head and chest 
in the palm of the left hand, while the right hand 






291 THE CARE OF THE XEW-BORX CHILD. 

bathes the head, neck, and back of the baby. All this 
should be done quickly but not slightingly. The baby 
is lifted from the tub into the lap, rapidly dried 
with the soft linen towel and a soft woollen blanket 
wrapped around him. The nurse can now sponge the 
face, if necessary, clean the eyes if they contain any 
secretion by gently holding the lids open and allowing a 
little water to trickle into them from a sponge, and 
always wash out the month with pure cold water and a 
linen rag over the end of the finger. If there is the 
least disposition to chafing of the .-kin. now i- the time 

to powderit quickly 
with the puff. If 
the ordinary rice 
powder does not 
help the chafing, 
use English fullers' 
earth. 'Hie baby is 
then dressed and 

Ft<;. _>o. Folding r.ath.Tui.. placed in the crib. 

I would especially emphasize the importance of a warm 
room, warm water, careful preparation, and rapid work. 

Some children are afraid of the bath-tub. These 
can he sponged off and given a mere immersion to 
rinse them in the tub. The folding bath-tub i- more 
convenient in some respects to use and softer for 
baby than the ordinary tin bath-tub. Any carpenter 
can make it easily. The legs are an inch and a half 
square and thirty inches long, crossed and pivoted on 
a central bar. The side bars fastened on top of the 
legs are one by two inches and three feet long: smaller 
strips join the legs near the bottom. Take a pi 




THE CARE OF THE NEW-BORN CHILD. 295 

of heavy rubber cloth a yard and a quarter long and 
thirty inches wide, with an inch wide hem at each 
end. This hem is used as a casing for a strong braid 
on which the rubber cloth is gathered back to eighteen 
inches with a plait in the cloth at each corner. This 
makes the ends of the tub. Fasten the braid securely 
to the ends of the wooden frame, and tack the sides 
of the rubber to the side bars of the frame with long, 
round-headed brass tacks, and the tub is complete. 
The tub can be folded up when not in use, and may 
serve as a temporary crib with a folded blanket in the 
bottom, so that it does not lie on the rubber. 

When the infant is cleaned by its first bath of sweet 
oil, the cord is to be dressed, taking care to notice once 
more that there is no bleeding from the cut end. The 
simplest and best dressing is to wrap a layer of dry, 
clean absorbent cotton around the cord, and then lay it 
flat upward on the abdomen and a little toward the 
right side. If there is no absorbent cotton at hand, use 
a piece of clean white linen three inches square, with a 
hole in the centre for the cord to pass through, then 
fold the linen around it and place the cord as stated 
above. The cord dries away and drops off on the fifth 
day as a rule . If there is no offensive odor or chafing, 
the dressing need not be renewed. If it has to be 
removed, soak it off with lukewarm water without 
disturbing the cord. 

If the navel is red and a little sore after the cord 
drops off, wash it with weak castile soapsuds night 
and morning and dry it carefully with soft linen. Then 
smear thickly Calendula cerate on a small piece of clean 
linen and apply it to the sore place. If the navel is 



296 THE CARE OF THE NEW-BORN CHILD. 

merely red without any secretion, do not wash it or use 
the cerate more often than every other day. Powder- 
ing the place with a little rice starch, or, if it cannot be 
obtained, cornstarch prepared as follows, will be suf- 
ficient : mix enough starch and alcohol in a saucer to 
form a thin paste. Let the alcohol evaporate, and use 
the powder. If the surface is a little red and only a 
trifle moist, the following powder will be preferable to 
the one just mentioned : equal parts of powdered starch 
and nitrate of bismuth with oxide of zinc, one eighth 
of the entire amount. The navel sometimes pouts out 
and protrudes; this may be the beginning of a hernia. 
Stitch a two-cent piece or a quarter of a dollar in the 
bellyband and put on the latter so that the piece of 
money will press on the navel and keep it in place. 

The bellyband is of little use alter the cord has 
dropped off, and may do serious injury when put on 
tight. Then, whenever the child cries, the abdominal 
pressure is transmitted to the inguinal rings, and hernia 
or rupture not uncommonly ensues. Always make 
it a rule to have two fingers slip easily under the 
band when it is applied. The idea that the band is 
necessary to support the abdominal walls is wholly 
false. Nature is by no means such a poor workman as 
some people would have us think. The band doe- give 
warmth and protection from chill, and for this reason 
is to be worn by children subject to diarrhoea and at the 
time of such a disease, but otherwise a warm knitted 
shirt answers every purpose. 

Feeding the baby before the milk come- w a per- 
nicious but common practice. Babies do not starvi 
is commonly thought, and feeding them witli molasses 



THE CARE OF THE NEW-BORN CHILD. 297 

and water, catnip or any kind of tea, gin and water, 
sugar and water or even milk, except as stated below, 
will almost always do harm, cause indigestion and colic. 
The only feeding allowable, except the nourishment 
from the breast, is two teaspoonfuls of warm water 
when the baby cries. The second day, if the child does 
not obtain much breast milk and cries a good deal, mix 
one teaspoonful of milk with two of warm water and 
give it not oftener than once in three hours if it becomes 
necessary to pacify the child. 

Proper nursing is of the utmost importance. Under 
the following conditions a mother should not nurse a 
child : the presence of pulmonary tuberculosis (con- 
sumption), or strong hereditary taint, scrofula, syphilis, 
childbed fever, abscess of the breast, and after the 
menses have returned. 

Some women do not have enough milk to nurse a 
baby (page 2SS), or else the milk is of too poor a quality: 
efforts to improve either condition are seldom thoroughly 
successful. Forced milk is very often of poor quality, 
— as a careful analysis will show. 

It is an important fact to remember that a child 
which nurses well and obtains as much milk as is neces- 
sary will always urinate often and profusely. This 
relation between nursing and urination is of great 
service as a guide to the amount of nourishment a child 
actually obtains in cases of sickness. A baby commonly 
has three or even four stools in twenty-four hours of a 
soft consistency and yellow color. 

The best evidence that a mother's milk is good is 
the way the infant thrives ; for the first ten days or 
fortnight the child will lose a little in weight. After 



298 THE CARE OF THE NEW-BORN CHILD. 

this it should gain from two thirds to one ounce a day, 
i. e., nearly half a pound a week for five months, and 
half that proportion after the fifth and up to the twelfth 
month. When the flow of milk is very excessive, it is 
often of poor quality ; the first that comes is inferior to 
the last. For this reason, apply the neck of a heated 
bottle to the nipple to draw out the first How of the 
milk, then the child can nurse and obtain the better 
quality of the secretion. 

The regular boms of feeding should be followed 
closely. It injures a child to nurse or feed it at irreg- 
ular periods. Frequent nursing cause- a concentrated 
secretion of milk which is almost sure to cause indig 
tioii, and nursing at long intervals product's a poor 
quality of milk which does not afford enough nourish- 
ment. GTntil the milk comes in the breasts, the child 
should be given au opportunity to nurse every four 
hours. It will not obtain much nourishment, but 
enough for its needs. If the baby cries much and an 
occasional teaspoonful of warm water doe- nol quiet it, 
a teaspoonful of a mixture of one part of milk and two 
of water can be given once in three or four hours, but 
anything else, such as sugar water, aniseed, or any 
other abomination so commonly used, must not be 
given. After the milk in the breasts lias come, nurse 
the baby once in two hours for the first week, once in 
two hours and a half after the first to the seventh 
week, and once in three hours after that time. A good 
way to begin is to nurse at midnight and not again till 
four o'clock in the morning. This interval can be 
gradually increased without remonstrance from the 
baby so that the mother can rest from ten to six ; but if 



THE CARE OF THE NEW-BORN CHILD. 299 

a period of nursing is once established between the 
hours mentioned, it is exceedingly difficult to discon- 
tinue it and causes much needless care and loss of 
precious sleep. A vigorous child ought to empty a 
breast in fifteen minutes. The infant should be trained 
to nurse till there is no more milk and then stop. 
Never allow a child to go to sleep with the nipple in its 
mouth or to prolong nursing needlessly. It soaks up 
the skin and softens it so that sore nipples are the 
result. Do not take up the child every time it cries or 
fondle it unless it is evidently in pain. It is a wonder- 
fully easy thing to get the child into habits which 
add very much to the amount of unnecessary care, 
and babies learn very soon that a certain amount of 
crying will bring petting and carrying. Nurse babies 
for four months if possible, and a year if the milk is 
good and the child thrives. It is a good plan for the 
mother to set her milk occasionally and observe its 
richness by the cream which rises. The same quantity 
of milk should be set in the same glass or test tube 
and at the same temperature. Mark the thickness of 
the cream on a piece of paper for comparing each test. 
In other words, weigh the baby every seven days, 
and nurse as long as the child is healthy and continues 
to gain in weight as previously indicated. Nurse in 
summers and wean gradually in winters. If a child 
does not nurse, the milk can be drawn with a breast 
pump and fed with a spoon. This is cleaner than a 
nursing bottle ; but if a baby is fed with a spoon for a 
few days, it seldom can be made to nurse. The 
nipples must be washed and dried carefully before and 
after each nursing. 



300 THE CARE OF THE NEW-BORN CHILD. 

A nursing woman should have an abundant but 
simple and nutritious diet, avoiding all sour food, 
drink and fruits, highly seasoned food and that which 
generates gas in the bowels, as cabbage, beans, peas, and 
also onions. She must be as free as possible from all 
mental anxiety. If by any means she receives a fright 
or becomes angry, she must never nurse her child 
within twelve hours afterward. The milk secreted at 
this time usually makes the baby sick, and must be 
drawn from the breast-. 

If the food disagrees with a baby or does not contain 
enough nourishment^ the following symptoms are likely 

to appear: If there IS a lack of good food, the child is 

only temporarily satisfied, and cries or fusses before i1 
is time for the next feeding ; besides this the child will 
Tail to gain, as it ought to do. in weight. If the food 
is not suitable for the infant, the baby i^ apl to have 
colic, to he fussy and irritable, to have a coated tongue, 
to cry after eating, to show white curd- or slime in the 
stools, to pass strong-smelling urine, which irritates the 
skiu, and the baby will not gain in weight. If th 
symptoms are not relieved, usually by a change of food. 
pallor of the lace with a thin, drawn expression, bright 
eves with dark streaks beneath them, nausea, vomiting, 
and diarrhoea appear, and the baby dies. 

Only part of the above symptoms may appear at the 
beginning, but a mother should know what they mean 
and not neglect the child's food till her baby is seriously 
ill. It sometimes happens that the mother's milk i- at 
fault, but indigestion is more commonly produced by 
prepared foods. No artificial food can replace human 
milk, no matter what the manufacturer may claim or 



THE CARE OF THE XEW-BORX CHILD. 301 

how fine the analysis may appear. The advertised 
analyses of infant foods are generally to be regarded 
with suspicion. 

A great deal of sentiment is foolishly wasted by 
some mothers in regard to wet-nurses. If the child 
does not thrive at its mother's breast, the best sub- 
stitute is always a wet-nurse, if a suitable one can 
be found. Never use so-called soothing syrups under 
any circumstances unless you wish to soothe your baby 
into its grave. A wet-nurse should have milk about the 
age of the child, of a good, white appearance and not 
of a bluish watery color. A single globule of good milk 
will remain on the finger nail. If one can afford it, her 
milk should be analyzed by a competent chemist, and 
not vary much from the following general average of 
healthy woman's milk. Slight alkaline reaction. Spe- 
cific gravity. 1028 to 1031:. 

Fat 3.00 to 4.00 parts. 

Albuminoids . 1.00 " 2.00 " 

Sugar of milk . 7.00 

Ash . . <>.5n 



i i 



Total solids . . 11.50 to 13.50 
Water . . 8S.50 " 86.50 " 



100.00 100.00 



A simple and excellent way of testing the milk is to 
see the infant which has been using it ; if that child is 
plump, well nourished, and vigorous, it is reasonable to 
believe that her milk is good. When the mother's milk 
is poor in fats and albuminoids, an increased amount of 
physical exercise often improves the milk. Large, fat 



302 THE CARE OF THE NEW-BORN CHILD. 

breasts are no sign of ability to secrete milk. The 
breasts should be of good size from the amount of gland- 
ular tissue in them, which is felt like good-sized por- 
tions of moderately firm tissue, Blightly irregular to the 
touch. Large, blue veins running over them, and large 
projecting nipples from which the milk will squirt out 
on squeezing the breasts, are good signs. The besl 
is from twenty-five to thirty-five. Blondes are some- 
what better than brunettes. A person of cleanly habits 
and of sunny disposition, with milk about the same 
as the infant she is expected to nurse, is very desirable. 
A sickly woman who has had many miscarria. 
or who suffers from any hereditary di 
scrofula, ought not to be engaged. Besides the contra- 
indications to nursing mentioned on pap' 297, there 
may be other reasons why a wet-nurse is not tit to 
nurse a child, which demand a careful examination of 
her by your family physician. When yon engagea wet- 
nurse do not allow her to care for her own child at the 
same time. Make her happy and comfortable ; give her 
light work to do, it will occupy her mind, and the exer- 
cise is good for her health. Vi^'d her on plain, good, 
nourishing diet, such as milk, beef, mutton, and 

ordinary vegetables. Over-feeding with rich food, to 
which she is not accustomed, may stop the secretion of 
milk or make it too rich for the baby to digest. 

Patent foods of all kinds are generally unreliable, as 
they do not correspond with the constituents and pro- 
portions of mother's milk, and the statements of an 
advertisement afford no guarantee of reliability. Many 
of the foods in a dry or powder form contain constitu- 
ents unsuitable for a young infant's stomach. Babies 



THE CARE OF THE NEW-BORN CHILD. 303 

fed on these foods often gain in fat but not in muscle, 
and in spite of a blooming appearance have very feeble 
powers of resistance if they are taken sick. Condensed 
milk, with very few exceptions, contains too much 
sugar. No one preparation of any kind is absolutely 
perfect, but mixtures of cows' milk are the best for 
nearly all cases. The milk from a good herd of cattle 
is better than the milk from one cow, as it will be more 
uniform in quality. Very rich milk, such as that given 
by Alderney cows, is too rich for a young baby ; milk 
from good native or Ayrshire cows is far better. The 
old-fashioned rule of giving the baby equal parts of 
milk and water, gradually increasing the proportion of 
milk as the baby grows older, is a good one, but careful 
investigations have shown much better Avays of prepar- 
ing the milk. 

Boiling the milk slowly for half an hour or more 
changes the taste of it. but it makes it much more 
digestible, and it also destroys nearly, if not all, the 
germs which cause diarrhoea and cholera infantum when 
taken into the stomach. This boiling, i. e., sterilizing, 
the milk has marked a great step in advance in infant 
feeding, and in the prevention of disorders of the 
stomach and bowels, especially during the summer sea- 
son. Over-feeding may be as much a cause of stomach 
disease as under-feeding. A baby's stomach is very 
small for the first few weeks, and will contain only two 
or three tablespoonfuls. 

Never neglect to weigh a baby every week and to 
write it down ; constant gain in weight is the rule for 
every healthy baby, and if this is not observed you may 
be sure that something is radically wrong. The follow- 



304 



THE CARE OF THE XEW-BORX CHILD. 



ing table indicates the feeding of the preparation 
recommended below : — 



Age of the 
Infant. 



Weight. 



Amount of Food at each 
Feeding. 



Frequency. 



Number of 

times 
in -24 hours. 



1st week. 

2-4 wks. 
4-0 wks. 
0-1 wks. 
IGwks.to 

6 urns. 

6-12 moB. 



6£ lbs. 
7 ll.s. 
8-9 11)-. 
B-13 Lbs. 

13-17 n.s. 

17-20 Lbs. 



1 § = 2 tablespoonfals. 
I. 1 § =3 tablespoonfals. 
2-2-i§ =4-5 tablespoonfals. 
2A-44 § = ")-!» tablespoonfals. 
4A-o§ = 9-12 tablespoonfals. 

0-85= 12-16 tablespoonfals. 



Ev'y 2 Ins. 
Ev'y "J Ins. 
Ev'y 2A In- 
Ev'y 3 ln-s. 
Ev'y 3 hrs. 

Ev'y 3 In-. 



LOtimes. 
10 times. 

8 times. 

6 times. 

6 times. 

."> times. 



In ,i general way it may be Baid thai the weighl of 
the baby is more important than its age, bo thai while 
genera] averages are indicated in theabove table, excep- 
tional cases are liable to occur which need differenl 
feeding, &fter the firsl month, add one ounce of* food 
(two tablespoonfuls) for every pound the baby weighs 
in excess of the weighl given in the table. The firsl 
thirty days of an infant's life is a critical period for the 
establishment of its digestion, and the utmosl care in 
feeding is necessary. If there are special reasons for 
extreme accuracy in feeding al tins time (i. > 
thirty days), the following rule is reliable : one one- 
hundredth of the baby's weight and fifteen drops for 
each day it lias lived will represent the amount t- 
fed once in two hours and ten times in twenty-four 
hours. Estimate a minim equal to a grain, sixty 
minims to a dram, and two drams to a teaspoonful, 
measured in a graduated -lass. 

If you are able to procure the thin cream extracted 

by machinery from fresh milk, take three tables] n- 

fuls of it and mix it with two tablespoonfuls of good. 



THE CARE OF THE NEW-BORN CHILD. 305 

fresh milk. Xext dissolve three and three eighths 
drams of sugar of milk in ten tahlespoonfuls of freshly 
boiled water and mix it with the milk and cream, then 
steam the whole in a sterilizer for half an hour, and 
afterwards add a tablespoonful of lime water, cork tight 
in small bottles and keep them in a cool place. Most of 
the ordinary cooking steamers can be used instead of 
the sterilizer if the bottles of milk will fit in the steamer 
under a tight cover. If the thin cream cannot be ob- 
tained, let a quart of milk stand for three hours in a 
high, narrow pitcher, and then carefully pour off the 
upper half of the milk without stirring it. Use ^.Te 
tahlespoonfuls of this rich milk instead of the above 
mixture of milk and cream, and prepare it in a similar 
manner. This preparation of milk is practically the 
same as mother's milk from a chemical point of view, 
but the test superior to aU others is the process of diges- 
tion in the infant's stomach. This always declares in 
favor of mother's milk. 

When a mother is travelling many days or weeks 
with her baby and with only short intervals of rest, it is 
difficult to procure fresh milk of uniform quality, and 
some other food can be used for the time being, such as 
unsweetened condensed milk. Eagle or Anglo -Swi>s 
condensed milk, or Mellin's food. I wish to repeat, 
however, and with emphasis, that in my opinion there 
is no patent food equal to the mixture of milk and 
cream prepared exactly as has been directed. 

The food should be given at exactly the same tem- 
perature each time. The nipple should be attached 
directly to the bottle and not connected by a rubber 
tube to the nursing bottle, which is worse than useh 



306 



THE CARE OF THE XEW-BORX CHILD. 



as it will cause a sore mouth. Wash the nipple thor- 
oughly before it is used for the first time; wash it before 
and after feeding, and when not in use keep it in fresh 
cold water. Select a nipple made of black rubber, and 
a short one rather than a long one which tickles the 
throat and makes the baby gag. Better have two tine 
boles which can be enlarged by a red-hot No. L2 needle, 

than a large hole in the nipple which allow- the milk 

to escape faster than the baby can swallow it. The 
Hub nursing bottle is excellent. The 

vent at the bottom allows the air to 

enter as the milk escapes. The baby 

is less likely t<> swallow air and t«» 
suffer from colic in consequence. The 
bottle musl he thoroughly washed 
and scalded alter each feeding. The 
sterilized milk can be warmed without 
emptying the sterilizing bottle by 
suspending the latter in warm water 
in a notched pi<-<<' of wood fitting 
around the neck of the bottle and 
tending across the vessel. There are 
three sterilizers used for preparing 
milk, any one of which i-> good, -Arnold'-. SoxL 
and Siebert's. Further information can bo obtained 
by addressing R. Van der Emde, Second Streel and 
Bowery, New York, or Eimer & Amend, comer of 
Eighteenth Street and Third Avenue, New York. When 
milk has not agreed with the baby 1 have used with 
advantage Fairchild& Foster's peptogenic milk powder. 
Its use should not be continued too long, lest the stomach 
become inactive from lack of exercising its functions. 




Fig. 21. 



THE CARE OF THE NEAV-BORN CHILD. 



307 



Lime water can be prepared as follows: mix in a 
glass a quarter of an ounce of powdered quicklime and 
three tablespoonfuls of water ; after slaking, add half a 
pint of water and stir it occasionally; let it settle and 
throw away the water. Add five pints of water to 
the lime which has 



settled, stir thor- 
oughly, allow the 
coarser particles to 
settle again, and 
pour off the turbid 
liquid into a glass- 
stoppered bottle. 
The top of this be- 
comes clear and is 
ready for use. 

Barley water is 
good for babies hav- 
ing a tendency to 
diarrhoea. Pick 
over and wash three 
tablespoonfuls of 
pearl barley. Cover 
it with cold water 
and let it soak four 
hours. Stir it all ^ 

illtO three CUpS Of Fig. 22. The Different Parts of the Arnold Sterilizer. 

boiling water in a farina kettle, cover the kettle, and 
let the barley cook for an hour and a half. Strain it 
through coarse muslin, and salt enough to destroy the 
flat taste. Keep it in a cool place and prepare it fresh 
each day. Use one part of this barley water to two 




308 THE CARE OF THE XEW-BORX CHILD. 

or three parts of milk, and add enough water to 
obtain the proportions of the sterilized mixture which 
is prepared and given in the usual manner. 

Oatmeal water is often excellent for constipation in 
infants. It can be prepared like the barley water, a 
tablespoon f'ul of oatmeal to a gill of water, or by pour- 
ing cold water through crushed oatmeal in a sieve and 
slowly cooking it down to the consistence of very thin 
gruel. Oatmeal should he strained through an ordinary 
sieve and not through muslin, as then the particles of 
husk are removed which relieve the constipation, oat- 
meal is likely t<> disagree with very young infants, and 
may cause a tine, rough rash on the skin, especially in 
the summer time. It is given the same as barley water. 

and more or less is added to the milk as it max agree 
with the child. 

Arrowroot should not he used till after the baby is 
a year old, and then sparingly. It contains too much 
starch. In fact, uo starch or sugar should be given to a 
child till after it drools lively. After a baby weig 
sixteen pounds, /. e., about the age of six months, the 
proportion of milk in the food can he increased, adding 

a teaspoonfu] of milk and subtracting a teas] nfnl of 

water once in two weeks or even a little oftener, if the 
baby continues to digest the food equally well. A baby 
weighing twenty- four pounds, and ten months old, ought 
to be able to digest pure milk. 

So long as the child is well and gradually gaining in 
weight, there need be no hurry in adding new article- of 
food, especially if it is teething, or during the summer 
season when the baby is more susceptible to changes in 
food than in the winter. After the second summer. 



THE CARE OF THE NEW-BORN CHILD. 309 

after the infant has sixteen teeth, it can be gradually 

accustomed to a larger dietary. Solid food should not 
be given till after the baby is a year old. A little mealy 
baked white potato, with a little butter and salt for 
seasoning, well baked stale bread and butter, an occa- 
sional plain cracker, with or without soaking in milk, 
mutton broth, red dish gravy from roast beef or the 
juice of a lightly cooked steak pressed out with a meat 
press, mixed with potato or bread crumbs, thoroughly 
cooked oatmeal, wheat in some form. Robinson's 
Groats, and Imperial Gramim are good articles of food 
to take occasionally in alternation with the regular 
milk diet. After the child is accustomed to these new 
articles of food, it can be given a piece of rare steak or 
rare roast beef to snck. a little minced chicken, beef, or 
a soft-boiled egg. Fruits, berries, and sweetmeats are 
not to be given, and the child should not be brought to 
the family table to be tempted by unwholesome food. 
It is often necessary to give a glass of milk or a piece 
of stale bread and butter at some regular hour between 
meals, but regularity in feeding must be strictly observed 
and no food be given at other times. This diet is ample 
tiU the child is three years old. 

Sweat in g of the head is common in children who do 
not have lime enough in the system. Such an infant is 
late in cutting teeth, which decay early ; the soft places 
in the head are tardy in closing up. the face is usually 
pale, a little blue under the eyes, and the expression is 
rather wan or pinched. Under these circumstances 
never forget the wonderful curative power of CcUcarea 
phos. o x trituration, a powder the size of a bean once in 
four hours. If nothing is done for such babies, rickets 



310 



THE CARE OF THE NEW-BORN CHILD. 



are liable to follow and cause some deformity of the 
bom 

When infants chafe about the groins, take special 
pains to see that the diapers arc thoroughly rinsed in 
clear water after washing them. Press out the wrinkles, 
but do not iron them hard. Nursery maids are often 
careless, use strong' soap or turpentine to wash the 
clothes, which will surely irritate the tender skin of a 
baby if these substances are qoI thoroughly washed out 
of the napkins. Sometimes the chafing is caused by 
unhealthy urine, depending on indigestion and improper 

fond. Rice powder 
or fullers' earth is 
an excellent appli- 
cation for chafing. 

Babies horn be- 
fore full tinu 
pregnancy are diffi- 
cult to rear, not 

only because the 

digestion is very 

fig 23. weak, often ni 

Tlic Incubator with trout cat away to show the post- aj+a+jncv tli<> infivi 
tion of the baby and the division ot the compartments. ^ ll «' ' in .-> UH mu o- 

duction of a small tube down the throat into the 
stomach to feed them safely, hut also from the well- 
known fact that their bodies do not generate heat 
enough to support lite to advantage. It i- necessary, 
therefore, to keep them warm. This i^ sometimes 
accomplished by a thick padding of lambs 1 wool 
around them, hut by far the best is the incubator, 
which can he made by any carpenter. The accompany- 
ing illustration gives a sufficient idea ot* the measure- 




THE CARE OF THE NEW-BORN CHILD. 311 

ments and principles for its construction. The lower 
compartment is heated either by the reservoir of warm 
water or hot-water jugs renewed as often as necessary 
to maintain a temperature of eighty-five to ninety de- 
grees as measured by the Fahrenheit thermometer tacked 
on the side of the upper compartment and in plain view 
through the glass lid. The child is kept all the time in 
the upper compartment, except when fed and bathed, 
which must be done in a very warm room. By the use 
of this incubator many children have been saved which 
otherwise certainly would have perished. 

Nursing sore mouth is nearly always due to lack of 
cleanliness of the child's mouth and the things taken 
into the mouth. The white, curdy spots are due to the 
presence of a parasite, the odium albicans. It is easily 
cured by scalding the nursing bottle and rubber nipple 
more thoroughly, or more carefully washing the breast 
if the baby nurses. Washing the baby's mouth with 
water containing as much borax as will dissolve in it is 
very effectual. I have seen remarkably good results 
and very prompt cures from the following wash : — 

H: Resorcin, .25 gm. 
Aqua, 150 gm. 

Sig. Mouth wash to be used mornings and evenings. 
Mercurius viv. 3 X , once in three hours, is a good 
remedy for sore mouth and canker if the gums are 
swollen and sore. Nux vomica 3 X once in three hours is 
better if the baby is constipated and suffers from 
indigestion. 



CHAPTER VIII. 

FACE, FORM, AND BEAUTY. 

The title-page of this book certainly dor- not 
suggest a chapter on cosmetics or dermatology, and yet 
the author believes thai mosl of his readers will be 
interested in the subject, for the simple reason thai 
women afflicted with diseases of the pelvic organs early 
lose the delicate, clear skin and rose-tinted cheeks so 
highly prized by beautiful women. The author desires 
to avoid "preaching," bu1 it should never be forgotten 
thai a woman is attractive more from a combination of 
charms than for any Bpecial one. Beauty alone is not 
enough, even in an educated person. How often a fine 
face is associated with poor carriage, a had gait, and 
faulty dressing! A woman having a plain face with 
much expression, an ereel bearing, a healthy skin, and 
good taste in dress, often becomes very attractive, far 
more so than the owner of a pretty face and nothing 
else. Good taste in dress, rather than expense or even 
fashion, is of no little importance and too often 
under-estimated. 

Ladies in general do not half appreciate how much 
an erect figure and good walking add to personal 
charms. It is ran 4 to see a woman with a really fine 
carriage which is independent of tight lacing in stiff 
corsets ; yet such a woman almost always has a 



FACE, FORM, AXD BEAUTY. 313 

distinguished appearance, independent of beauty or 
even costly dress. 

A tine carriage means an erect, straight figure with 
the shoulders well back, the chest forward, and the chin 
drawn in a little. It is hardly necessary for a girl to 
go through the "setting up" of a West Point cadet, 
but there are various things she can do with great 
advantage toward developing a fine figure. It is 
important to remember that the best results are 
obtained by early training, and that efforts in this 
direction after the age of twenty usually are unsuc- 
cessful. The proper time to begin these exercises 
is at the age of twelve or fifteen, and they should be 
continued persistently for eight years, till the habit of 
erectness and good walking is so fixed it will remain 
through life. The usual training in a ladies' gymna- 
sium is of material benefit, but comparatively few 
girls can enjoy such privileges. It is an easy thing, 
however, for a girl to walk ten minutes every day in 
her room, with a light book balanced on top of her 
head, her shoulders drawn back, her chest thrown out, 
her figure erect, her elbows pressed close to her side, 
and the palms of her hands turned toward the front, or 
instead, her elbows can be drawn back so that a cane 
can be passed behind the back and in front of the 
elbows, and the toes turned out at an angle of forty-five 
degrees. The cane between the elbows and the back is 
an excellent exercise in connection with horseback 
riding. The erect position given by such exercises 
should be carefully maintained in walking about the 
house or the street till it becomes a fixed habit. If 
young ladies knew how much more attractive they 



314 FACE, FORM, AND BEAUTY. 

were in consequence of simply having a fine carriage 
and an erect position, these exercises would be the 
constant fashion. It may he well to remark here, that 
the habitual use of the rocking-chair is almost sure to 
destroy an erect position. High-heeled and tight shots 
make it almost impossible for a girl to walk well and to 
stand straight. 

Corsets may improve the fitting of a dress and 
appear to support the body, hut they weaken the 
abdominal muscles, and when they are tight do serious 
injury to the generative organs. The hand always 
should slip easily up and down beneath the corset. It 
is hotter for a girl to wear a waisl and only put on 
a corset tor nnnsnal dress occasions, than to wear 
habitually a corset. A hard, rigid corsel should not he 
worn, dot should the weight of tin- skirts come over 
the abdomen and hips. The Equipoise corsel ha- been 
very satisfactory to some ladies, and the Jeaness Miller 
COStume avoid- very many of the objections to the 

usual mode of dress. 

Good complexion- are host obtained and preserved 
by attention t-> the usual rules of health, such as 
moderate exercise in the open air. plain food, no rich 
pastry, very few sweets, no oatmeal in warm weather, 
and hut little buckwheat at any time, and to securing 
daily evacuations of the bowels. Never touch any 
pimples on the face, as they are liable to spread. Tea 
drinking spoils a fine complexion. Go to bed early 
in the evening, hut do not sleep late mornings. It i- 
better to take a second nap in the day than to lie abed. 

A good complexion is quite independent of features 
or of figure, and can hardly he limited to any one 



FACE, FORM, AND BEAUTY. 315 

shade of color. It must have certain characteristics, 
such as clearness, delicacy of skin, and freedom from 
blemishes. A fair white skin and cheeks of a delicate 
pinkish hue, which easily comes and goes under the 
influence of mental emotions, is generally the most 
desired, even though fashion may sometimes demand 
more color in rose or brown shades. Bright eyes 
with clear, liquid depths, large pupils, long eyelashes 
surrounded by clear, white, un wrinkled skin, add much 
to a girl's face. 

Young ladies who do not care for beauty are 
certainly few in number, and yet a large majority 
of them entirely ignore these things of the utmost 
importance. A fine complexion almost invariably 
requires good health and healthy Jiving, and for a third 
thing, beauty once lost is seldom restored. Complexions 
are the gift of nature, and are not to be manufactured 
to order by any one. Art can never compete with 
nature. A girl without this gift will do far better to 
improve in charm of manner rather than to attempt 
to acquire artificially what nature has denied her, 
remembering that most young men like a pretty face 
to flirt with, but not to live with. 

These sentences are not to be construed into 
meaning that it is useless to attempt any treatment for 
the skin. It is often susceptible of much improvement 
if the right measures are employed. The removal of 
blemishes, such as moles, coarse hairs, spots, freckles, 
pimples, excessive oily secretion, etc., often makes a 
wonderful transformation in a girl's face. Much can 
be accomplished in preserving youthful beauty, and the 
real secret of it lies in good health and hygiene rather 



316 FACE, FO&M, and beauty. 

than by artificial means, though the latter may be 
helpful when intelligently employed. 

The pinkish color of the skin depends upon an 
innumerable number of minute capillary blood-vessels 
on the surface, and the red color of the blood 
circulating in these capillaries shines through the 
surface and gives the skin its rosy hue. It is evident 
that if the blood becomes pale and watery, or if it 
circulates poorly, the color of the skin will be affected 
directly by it. A deficiency of hemoglobin in the 
blood is commonly shown by an unhealthy, dirty-white 
skin. It is also apparent that what brings healthy 
blood to the surface, and makes it circulate there, will 
preserve this rich color of th» i skin. A clear skin ninst 
be healthy in all its functions and belong to a healthy 
body. The glands (pores) musl secrete freely watery 
and not an oily perspiration. 'Hie latin- i> often 
accompanied by large pores, giving a coarse appearance, 
and which also till with dirt causing pimples witli 
black heads. The digestive organs musl act well. 
Dyspepsia and constipation are common some*'- of 
unhealthy skins. Uterine troubles often cause pimples 
or a haggard look, especially about the eyes. An 
unhealthy action of the liver is a common cause of 
yellow eyes, sallow skin, or yellow spots about the 
eyes, bridge of the nose, or around the mouth. 
Deficient action of the kidneys produces bloating of 
the face, a waxy skin, and putting under the eyes. 
Very many girls are troubled with pimples at the age 
of puberty, which disappear when regular, healthy 
menstruation is established. 

The author desires once more to emphasize that the 



FACE, FORM, AND BEAUTY. 317 

first requisite for a fine skin is to have a healthy one. 
and unless good health is present, not much can be 
accomplished by any treatment. Most of the prepara- 
tions advertised for the skin are of no value, or are 
actually poisonous. In no department of medicine are 
absolutely pure drugs and carefully prepared fats more 
necessary than in toilet articles. The author intended 
to publish in full the formulas for the various articles 
mentioned, but in many of them it is very uncertain as 
to whether the best of materials could be obtained, or 
the best processes of manufacture would be observed. 
The publishers have therefore decided 
to have some of the most important and 
reliable preparations carefully prepared 
by an expert with a distinct name and 
stamp which insures their genuine char- 
acter to any one desiring to purchase the 
preparations from them. No arsenic, 
lead, poison, or any injurious ingredient 
will be employed except as it is printed Trade-mark of the 

1 J r * preparations recom- 

j-i i i,.-.i mended and found 

Oil Llie lauei. only on these articles. 

Gymnastic exercises will do much to develop the 
muscles and give symmetry to the figure. Thin, 
scrawny necks and high collar bones, also small, poorly 
developed busts, can be improved by daily rubbing and 
kneading the muscles of the neck and chest, also the 
breasts, with pure olive oil or melted refined cocoa 
butter. This should be accompanied with shoulder 
exercises, as rotary motion, moving the shoulders up 
and down, and forward and back ; swinging the arms 
round over the head, and forcible extension and flexion 
of them, also promote the development of the muscles 







318 FA( 

of the chest. Patient, daily practice of the above 
directions, for at least a month, is almost certain to 
bring improvement. 

Water is one of the most valuable of all cosmetic 
agents ; together with soap, its use measures the degree 
of civilization. Aside from cleansing purposes, the 
action of hot or cold water has a decided therapeutic 
effect; as drink, it improves nutrition, and thus 
indirectly does much to improve the health. Water, 
as commonly employed, is often impure; lim<- i 
common ingredient, and then the water is called hard 
in contradistinction to soft or rain water, which is 
free from mineral salts. "Hard water" is usually 
preferred for drinking purposes, bul salts of calcium or 
magnesium in it make the delicate skin raw and coai 
In other words, pure water, free from all organic or 
inorganic ingredients, should be \\^<\ for the face and 
hands; rain water is one of the nearest approaches to 
pure water. Distilled water can he obtained for a 
moderate price in most cities. Hard water is purified 
in a measure by boiling, or by the addition of a little 
ammonia to the water, enough for the water to hai 
slight odor of ammonia after stirring it. Ammonia 
and water is excellent to cleanse the skin when it has 
been covered with profuse perspiration, and also after 
the bites of insects. Alcohol in water Leaves a pleasant, 
cool effect after the bath, which arrests perspiration 
for a time, and is very agreeable in warm weather. 
Bay rum has a similar effect, ami its fragrant odor 
is preferable to alcohol for some ladies. In either 
preparation the evaporation of the spirit diminishes 
the temperature of the skin, while at the same time it 



FACE, FORM, AND BEAUTY. 319 

stimulates it and makes it less susceptible to change 
of temperature and drafts of air. This is taken advan- 
tage of by physicians who often order alcohol, bay rum, 
or whiskey and water, for bathing the neck and chest of 
people who easily take cold, and are very susceptible to 
drafts of air. A favorite method of my own is to use 
daily the pure alcohol with a fine hand spray, about 
the throat and chest, followed by vigorous friction with 
a coarse towel. Vinegar in the water, just enough to 
give a slightly sour taste, is helpful for a very oily skin. 
Soap is commonly used with water for cleansing 
purposes. It is hardly necessary to describe its 
chemistry or process of manufacture. Cheap soaps 
strongly scented, or strong alkaline soap, should not 
be used on a delicate skin ; indeed some ladies must 
dispense with soap entirely. The white olive-oil soap 
and the Eussian egg soap are among the best toilet 
soaps. An abundance of lather is not necessarily a 
test of a good toilet soap. After using soap and water 
never neglect to rinse the skin with pure water, as 
the soap left on the skin is apt to make it coarse. 
Glycerine or transparent soaps are very apt to be 
impure and unfit for use. If you wish to prevent 
wasting of an expensive soap, keep it in a wire lack 
where it will drain freely and not soften in water. 
Pumice-stone soap is excellent to scour stains from 
the fingers. Washing powder, composed chiefly of 
almond meal, is an excellent substitute for soap, where 
the latter cannot be used. Unfortunately the value of 
this powder is not generally known to ladies who have 
very delicate skins. This same powder is also valuable 
when the skin does not tolerate water. 



320 FACE, FORM, AND BEAUTY. 

Bathing. — The skin of some persons, especially on 
the face, is made rough and chapped by water. In some 
instances this is due to not carefully drying the skin or 
not rinsing off the soapsuds after washing. The fre- 
quent use of water on the scalp is very apt to produce 
dandruff, falling out of the hair, and baldness. Frequent 
bathing in hot water relaxes the skin, dilates the blood- 
vessels, and makes the individual more susceptible to 
atmospheric changes. The excessive use of cold baths 
makes the skin dry. leather-like, without elasticity 
fat. On the other hand, an occasional cool hath tones 
up the system, brings color to the cheeks, and has an 
excellent effect on the general health. Cold-water 
baths should be taken in a warm room, and only by 
persons of good reaction as shown by the glow of the 
skin, and a feeling of warmth from vigorous friction 
with a coarse towel after the bath ; five to ten minutes 
is enough for either hot or cold baths. Sponges are 
apt to become greasy <>n the surface in a short time. 
For this reason the Egyptian loofahs are preferable. 
It is said that Egyptian women are much indebted 
to these loofahs for their tine complexions. It i 
good plan to follow a lukewarm bath with sponging 
off in cool water. People who suffer from eczema 
(salt rheum i should apply water very sparingly and 
then carefully dry the skin. 

Inunction with fats after the bath is an excellent 
means of protecting and preseiving the skin which 
is not generally known or appreciated. It was chiefly 
by this means that the Grecian and Roman ladies in 
ancient times preserved the beauty of their skin to a ripe 
old age. Fats should not be employed as cosmetics 



FACE, FORM, AND BEAUTY. 321 

when the skin itself contains much fat, excretes much 

oily perspiration, or in which there are many large hard 

pimples which fester or contain black points. They are 

chiefly indicated by a rough, dry, and dull skin. Fat is 

applied to the skin by rubbing it in lightly with the hand 

except on the face, when a piece of soft old linen is 

better than the hand. The best time to use a salve or 

pomade for the face and hands is on going to bed, after 

washing and thoroughly drying the skin. If used at 

other times when a prolonged application of the fat is 

not desired, the pomade can be wiped off with a cloth, 

leaving a very thin layer on the skin which is excellent 

to retain any powder dusted upon it. 

When a more effectual application is desired, take a 

pair of suede or doeskin gloves, turn them wrong side 

out, coat them with the salve and put them on the 

hands, reversing the gloves as they are drawn on the 

hands. Some ladies prefer to anoint the hands and then 

draw on the gloves ; others prefer to knead the gloves 

in a mixture of almond oil and yolk of egg, to keep 

them in a cool place, and to wear them all night. 

Almond powder and Standard Honey Almond Meal are 

mixed with water to a thick cream consistency, applied 

to the face and hands at night, and wiped or washed off 

the next morning. The author can recommend the 

following pomade for general inunction of the body 

after the bath and for massage: — 

R Lanolin anhyd. § iii. 

01. caco §i. 

Vanillin gr. vii, 

S. Pomade. 

Standard Pineapple Cream is very cooling to the skin 
and refreshing, especially in the summer time, and as 



322 FACE, FORM, AND BEAUTY. 

it is an excellent beautifying agent, it is very popular 
with many Vienna ladies. When ordinary fats are dis- 
agreeable and glycerine does not agree Avith the skin. 
Standard Snowflake Cream lias met with deserved 
favor. Standard Cold Cream, perfumed with roses or 
violets, is a very superior preparation of this kind, and 
is good for roughness or chapping of the skin, as well 
as to preserve it. When the skin of the face or hands 

becomes dry, rough, and raw. water should nol be 
used, and Standard Boney Almond Meal is an ex- 
cellent cleansing agent, while at the same time it 
heals the skin and makes it tender and flexible. 
Standard Dent de Lion Creme (Dandelion) is a popular 

application to BOfteD the Bkin, and Standard French 
Cream has proved of more than ordinary efficacy in 
beautifying and preserving the skin, as well as soft- 
ening a rough skin. Like Standard Vienna Cream, it 
dries Immediately without heat or leaving the Bkin 
greasy, so that the most delicate glovje can he worn 
without injury three minutes after il is applied. Prep- 
arations of glycerine are poisonous t<> many < It ^1 i - 
skins ; others find them very helpful, standard Alm- 
ond oil and Glycerine has been used with much 
success to cure chapped lips and to soften a rough 
skin. It combines the properties of two of the 
host agents ior healing the skin, and is the besl 
preparation of glycerine for that purpose. Standard 
Vienna Cream is better for very had cases, and when 
glycerine poisons the skin. 

Alcohol ranks second to water as a beautifying 
agent for preserving a fresh and rosy complexion. It 
must not be diluted too much, nor should very strong 



FACE, FORM, AND BEAUTY. 323 

alcohol (ninety-five per cent) be applied directly to the 
skin. Strong alcohol takes ont the water and fat, and 
makes the skin dry, dull, and lustreless. When the skin 
is oily or the perspiration is excessive, especially about 
the hairy parts, strong alcohol or brandy can be used to 
remove it. The proper amount of dilution is to buy 
ninety-five per cent alcohol, often called absolute alcohol, 
and mix one part of this with three parts of water. 
Some wines containing about this percentage of alcohol 
are used for toilet purposes. Natural red wines are not 
as well suited to this purpose as the light ones, on account 
of the tannic acid present in them. 

Stimulation of the skin to increase its color, 
freshness, and tone is obtained by other agents than 
those just mentioned. Preparations of some of the 
balsams are quite effective, but they should not be 
used continuously ; they will finally cause in some 
persons a little roughness of the skin, and pimples. 
Varying the use of these preparations with the use of 
alcohol will almost certainly obviate such a conse- 
quence. A very excellent and popular preparation of 
this kind, used in France, is called Lac Virginis, or Lait 
Virginal. Most of the cosmetic fluids (laits) of this 
kind contain lead and mercury. These poisons for a 
time increase the activity of the preparation, but they 
are very dangerous to use, and ultimately injure the 
skin. 

Cosmetics are employed in both liquid and powder 
form. The latter is used chiefly, as it is best adapted 
to both daylight and artificial light, and more espe- 
cially the white and red preparations. It should be 
remembered that circumstances govern the appli- 



324 FACE, FORM, AND BEAUTY. 

cation, whether daylight, gas light, or electric light ; 
the stage or the drawing-room ; each one requiring a 
difference in color and use of the cosmetic. I quote 
from a clear description of the use of powders by a dis- 
tinguished Vienna writer : "The face is first greased 
with one of the solid pomades, such as paraffine, 
cold cream, or glycerine. No part of the face may 
be omitted, and special attention is to be given to 
the entrance of the nose, the eyelids, and both sur- 
faces of the auricle; the superfluous grease should be 
removed with a soft cambric doth. White powder 
is then dusted on, and the superfluous amount also 
wiped oh" with a cloth. Next a more or Irs^ saturated 
red is put on near the month and nose and rubbed 
toward the ear. Since rosy ears are admired, th 
,-dso must ho covered. The cosmetic, when applied, 
must he exactly as desired: corrections are not often 
successful, [f it he not altogether right, it i< Letter to 
remove it and begin anew. For laying on the white 

powder, a hare's toot is used, or a hit of down from the 
skin of a swan or a goose : for the actual cosmetics a 
little cushion is preferred, made of white plush, or a 
very soft thin eamhrie. For artificial light, and when 
the face is pale, only red is used, a red grease cosmetic 
being applied to the previously oiled skin. A cloth or 
the fingers are u^-d for this purpose. The red cosm 
is best made byrubbingup fine carmine and glycerine 
with the finger. This is then applied to the cheek and 
spread out with a soft cloth ; with some experience 
this is very successful. Blondes should not use too 
much red. 

" Moist cosmetics are applied with a soft earners- 



325 

hair pencil, left until dry. and the excess then wiped off 
with a cloth. Experienced persons never use these on 
the face, at the most only on the arms and neck, since 
the white that they give is too intense and makes the 
complexion sallow and yellow under artificial light. 
The moist cosmetics are the most harmful of all, since 
they are more sure to cause hlack-headed pimples, and 
for this reason they should not be used on the face. 

" Such a broad use of the cosmetic is not enough as 
a rule, and detail must be added later. The nostrils are 
made red with grease cosmetic ; the internal corner of 
the eye is reddened, and the palpebral fissure is 
lengthened by a black stripe from the outer angle of 
the eye. A similar stripe is drawn on the hairy border 
of the lower lid to make the eye brilliant and conspic- 
uous. In order to give the face a certain je nesais quoi 
of revery or wantonness, a weak black shadow is 
laid on the lower lid corresponding to the orbital 
margin, and this makes the eye seem deeper and more 
languishing. All these little deceptions are necessary 
for appearance on the stage, but in daily life, if not 
artistically applied, they appear like flecks of powder 
when seen in the house or on the street, and like 
hollows in the cheeks when seen on the stage. 

*• The eyebrows, when too short, or thin, or light, 
are lengthened and darkened with brown or black 
(lampblack) grease cosmetic, applied with a soft brush. 
The shape and direction are also improved and the 
deception is made more complete by the fine marks of 
the brush. If not too great an effect be required, it 
can be obtained by an almond half burnt over a candle, 
or the black cosmetic can be applied with a pin when 



326 FACE, FORM, AND BEAUTY. 

it is only wished to give a better arch to the brows. 
The line on the border of the eyelid next the lashes can 
be drawn in this manner, or the line for the purpose of 
lengthening the palpebral fissure (space between the 
eyelids). Lips which are too narrow and too pale 
are often treated with cosmetics. Only red gn 
cosmetics, and such as are not poisonous, cinnabar 
excepted, are to be used. The paint must not extend 
beyond the red membrane of the lips. The broadening 
of the red line of the lips with paint is only practised 
on the middle of the upper lip." (Cosmetics, Paschfc 

Cosmetics should not be allowed to remain on the 
face more ihau a lew hours, as their frequenl and 
prolonged use will injure the skin. Water will rem 
powders and moisl cosmetics. Grease paints and 
powders applied on a greased skin are to he removed 
by rubbing on more grease and then using soap and 
water. 

The author desires to remind his leaders that such a 
use of cosmetics should he restricted to theatrical pur- 
poses. They seldom hear close inspection in daylight, 
and a woman known to use them is subject to com- 
parison with the demi-monde. He know- tew tin 
more ridiculous than to see women of titty and over. 
painted, powdered, wigged, and dressed like girls of 
twenty. He wishes to emphasize what has heen said 
before, that good health and good care of the skin are 
the secret of beauty. A complexion once lost scarcely 
ever is restored, and art will certainly tail to supply the 
perfect tints of nature. 

A large proportion of the face powders on the mar- 
ket contain metallic salts, which are deadly poisons. 



FACE, FORM, AND BEAUTY. 327 

White lead is a very common ingredient of the white 
powder, and has poisoned many a woman. It may be 
interesting to note that when a woman using cosmetics 
containing lead takes a bath in sulphur water her skin 
turns gray or black. 

The constant use of any powder finally will spoil 
the skin, but the simplest and least injurious of all is 
Kice Powder, and most of this in the shops is adulter 1 
ated. Gentlemen find it refreshing to apply with a 
puff after shaving, on account of its absorbing and 
cooling properties. Silicate of magnesia is employed 
by some who rub it on the face with the fingers, and 
then wipe it off lightly with a soft cloth. Talc powder 
is another simple and excellent powder which can be 
mixed with starch to advantage. A good white con- 
cealing powder is made of six parts of oxide of zinc, 
ten parts of talc, and one part of carbonate of mag- 
nesia. Increasing the oxide of zinc and decreasing the 
talc gives a stronger white. This rule answers well for 
home-made articles which can be prepared by any drug- 
gist. The really delicate and finely prepared Face Pow- 
ders such as those bearing the Standard trade-mark 
and stamp (page 317) require special facilities, delicate 
materials, and the long experience in which the French 
excel all other nations. 

Care must be exercised in using very Avhite pow- 
ders, as they are likely to disfigure the skin, giving 
a clown-face appearance. On this account a little 
carmine is often added. It is sometimes necessary to 
apply a little spermaceti or cocoa butter to the skin, 
carefully wiping off all excess, before the powder can 
be applied effectively with the puff. 



328 FACE, FORM, AND BEAUTY. 

The Standard Cosmetic or Rice Powders are free 
from the poisonous substances often contained in face 
powders, and are the only preparations to apply when 
powder must be used. Standard Poudre de Perles ad- 
heres to the skin better than some of the other prepara- 
tions, and has excellent concealing properties. Standard 
Vienna Cream is a good fluid white cosmetic. It pos- 
sesses valuable healing and beautifying qualities, is 
good for light freckles, coarse pimples, sweaty hands, 
and for a rough, oily, or chapped skin. Carmine is 
used in water for a red cosmetic. Pastes arc preferred 
by some for bleaching or beautifying fche skin. 
powders or liquids, ('rushed Violets (Standard) are 
said by a French author to lend the skin freshness, and 
t»> remove ml blotches and freckles. Nearly all of the 

cosmetic powders cm he made into pastes by adding 

spermaceti. The old-fashioned and popular white bread 

and milk poultice, applied at [light with a cloth mask, 
lias still many warm friends, for freshening and bleach- 
ing fche skin, though it is inferior t<» the less eleganl 

method of using lively very sour milk in the same way. 
Brown and cream effects are ohtained by using ochre 

as in the Standard Rachel powder. 

Complexion powders contain arsenic, a- a rule, and 
in spite of the advertisers' assertions of their harmli 
ness, they are deadly poisons, sure to injure the health 
and ultimately ruin health and all its charms. Tl 
powders are never to he taken und»-r any circum- 
stances. 

The natural conditions of the complexion, the means 
of preserving and beautifying it, have been sufficiently 
considered, and the author proposes now to describe the 



329 

more important methods of treating blemishes and 
similar conditions which are more or less directly con- 
nected with this subject. 

Wrinkles are sure to appear as age advances, and 
if they remain for any length of time, they become 
permanent. Wrinkles are due to absorption of fat 
beneath the skin, and to a loss of elasticity in the latter. 
Treatment must be directed to replacing the fat which 
has been absorbed, and to strengthening the skin. In 
rare cases the k ' crow feet " about the eyes can be 
removed by a simple operation. Fat is supplied by 
rubbing in a fat which is easily absorbed. The greatest 
care is necessary to obtain very pure materials, as they 
are absorbed directly into the system. Lanolin, which 
should be entirely free from fatty acids, forms the chief 
part of ointments to remove wrinkles. One of the 
very best of these is the following receipt, when it is 
carefully prepared from very pure materials : — 

K: Lanolin anhyd., § iii. 

01. Cacao § i. 

Vanillin gr. vi. 

S. Pomade. 

Rub it freely night and morning into the wrinkled 
skin. Standard Honey Almond Meal is another prep- 
aration of considerable merit. When the first signs 
of wrinkles appear use the Standard Lait Virginal to 
stimulate the skin, and to give it tone and freshness. 
Enamels are used for stage purposes and by some society 
women. They are only suitable for "evening wear," 
and when cleverly put on will conceal many blemishes, 
but a close observer readily detects the presence of any 
enamel. These act by filling up the wrinkles and 
making smooth the surface of the skin. Repeated 



330 FACE, FORM, AND BEAUTY. 

applications of enamel, powder, or grease cosmetic to 
the skin will lead almost certainly to ugly pimples and 
blotches which no amount of cosmetics will conceal. 
It is better to use a good concealing powder like the 
Standard Poudre de Perle than enamels. 

Freckles disfigure ninny a face, and many are the 
lotions for curing them. A freckle is a pigmented spot 
in the superficial layer of skin. Consequently, if this 
layer of skin is removed, the freckle goes with it. and 
leaves bare the now. clear skin beneath the original 
freckled layer. This is the basis of treatment, and the 
lotions act by removing the outer layer of skin, leaving 
the delicate, tender skin denuded of its former covering. 
This new skin i^ exceedingly tender, more -<>. for a time, 
than before the application of the lotion, and will easily 
freckle again. 

It is obvious that a person cannot continue t<> remove 
layer after layer of skin, he it ever 80 thin, and after 
freckles are removed great care musl be taken to avoid 
any exposure to the sun's rays, even so much as facing 
the sun in the shade of the piazza <>f a summer hotel, 
and especially avoiding the rays of the sun reflected 
from water, and the wind which is almost unavoidable 
in boating or sailing. The same i> line of tan. Indeed 
the very best remedy tor freckles is prevention. Most 
of the freckle lotions on the market contain corro- 
sive sublimate, so that while it is one of the most 
effective agents for removing freckles, it i- a deadly 
poison and should be labelled very plainly Poison. 
The selection of a remedy to remove freckles must 
depend somewhat on the nature of the case. When 
they are very few in number and light colored, each 



FACE, FORM, AND BEAUTY. 331 

one can be removed separately by applying only to the 
freckle a little Standard Parisian Freckle Cream, or if 
the freckles are lig v ht colored, superficial, fine, and not 
numerous, by using freely Standard Vienna Cream, 
which is excellent for oily skins, pimples, and freckles 
which are present to a moderate degree. Freckles are 
not removed permanently so easily as might be desired, 
and the liability to recurrence must be remembered. 
Severe cases of very dark, coarse, deep-seated freckles, 
yellow patches, or liver spots require very strong prep- 
arations, such as the Standard Parisian Freckle Cream, 
or the Aqua Orientalis, which is a little milder and 
better suited to a very delicate skin. The last two 
preparations contain corrosive sublimate, and should 
not be used on an inflamed or chapped skin. They 
sometimes cause a little irritation of the skin. Should 
this occur, omit using the preparation for a few days 
and apply Standard Cold Cream, Standard Lillien 
Cream, or Standard Marshniallow Cream freely, which 
will give prompt relief. 

Tan and sunburn are closely related, the latter being 
an acute inflammation of the skin from exposure to 
the sun's rays. In mild cases of sunburn I know of 
nothing so cooling and refreshing to the heated skin as 
the Standard Pineapple Cream, which is also a perfectly 
safe beautifying agent. When the burning and smart- 
ing are very severe, rub in freely Standard Sunburn 
Cream. Standard Lillien Cream, Standard Marsh- 
mallow Cream, or Calendula jelly. Any one of them 
is excellent. Standard Rice Powder is very superior to 
the usual starch powders, and has a fine, soothing effect 
when powdered liberally on the skin. In less severe cases 



332 FACE, FORM, AND BEAUTY. 

Standard Cold Cream is an efficient remedy. AVlicii it 
is desired to remove tan, apply the preparations men- 
tioned for freckles in the same manner and according 
to the amount of tan, remembering that the new skin 
will tan very easily. 

Prickly heat is closely allied to sunburn, and any of 
the preparations mentioned for the latter is good for 
prickly heat. An excellent and simple remedy is pre- 
pared by mixing equal parts of olive oil i salad oil i and 
lime water. Shake the mixture thoroughly and apply 
it freely to the affected skin. 

Yellow spots on the skin are often called liver spots, 
as that organ is so often deranged when these 3] 
appear. They are seen either as distinct yellow patches 
on the forehead or over the nose, or in the form of 
yellow streaks which are no1 sharply defined hut fade 
into the color of the surrounding skin. The latter 
form is often seen aboul the mouth and below t 1 
often with a yellow hue of the white of the eyes. The 
firsl form, /. e., spot-, is often seen in pregnancy and 
among women suffering from pelvic dis< A dose 

of Sepia** half an hour before each meal is often 
very beneficial in clearing the skin from them. Mosl 
of the strong freckle lotions will aid materially in 
removing them. Marchand's Peroxide of Hydrogen 
applied freely to them in full strength can do no harm, 
and is an excellent bleaching agent. It bleaches hair 
to a light yellow color, and care must he taken not to 
touch the hair with it unless such an effect i- desired. 
The yellow streaks aboul the eyes and mouth are due 
usually to an overproduction of bile, which i< not 
carried away fast enough by the bowels and is absorbed 



FACE, FORM. AXD BEAUTY. 333 

into the system. A cathartic often increases the action 
of the bowels, takes the bile out of the system, and 
clears the complexion. 

Red scaly sjiots which appear scurfy or chafed are 
most often seen about the corners of the mouth and 
nostrils. "When accompanied by blistering of the skin 
these spots are called "cold sores," as they are often 
associated with taking cold. The treatment of "cold 
sores " proper will be mentioned later. There are sev- 
eral good remedies for red, scurfy spots on the skin. 
Lemon juice is a domestic remedy of long use. It is 
rubbed in on the spot, or a slice of lemon is bound on 
the spot over night. This is also used for freckles and 
chilblains. When a good deal of perspiration accom- 
panies these red spots, the treatment recommended 
for excessive perspiration should be employed, and 
Standard Marshmallow Cream or Lillien Cream is 
an invaluable remedy. Vinaigre Cosmetique is suited 
only for cases where the spots are light colored and 
have appeared only for a short time and are accompa- 
nied by a greasy skin. Standard Marshmallow Cream 
is almost a sure cure for reddish blotches, small pimples 
without heads, all moist or red eruptions, and is excellent 
to freshen the skin. The writer can recommend very 
highly Standard Lillien Cream for scurfy, red, inflamed 
spots, fissures, and rawness of the skin. It is excellent 
for cold sores when once formed, and also for inflam- 
mation of the eyelids, and if carefully prepared is an 
invaluable ointment which is either unknown to the 
majority of physicians, or not appreciated by them. 
Calendula jelly is good for all raw sore spots on the 
skin. Both of these last preparations are recommended 



334 FACE, FORM, AMD BEAUTY. 

for cold sores. When young ladies find themselves 
suffering frequently with cold sores from taking cold. 
Rhus tox. 3x and Antimonium tart.**, taken alternately an 
hour and a half apart, commencing immediately when 
the first symptoms appear, will often stop them and 
prevent recurrence. When there is much swelling of 
the lips, especially the upper one, take Apis**, a d 
once in two hours till better. One thing of special 
importance should be remembered if young ladies wish 
to avoid cold sores. 11 is a well-known fact that they 
occur chiefly in persons who are overworked, ex- 
hausted, and doing too much. In other words, plenty 
of sleep, fewer parties, and Less mental and physical 
work. i. e., rest, is the chief thing for a <\nr. 

Ncevi, or red patches with smooth skin (birthmarks), 
or large hairy moles, are quite different from the ah 
mentioned "red spots," and can be cured as a rule by 
electricity. This requires special knowledge of the 
subject. Waits and moles can he removed easily in a 
similar manner. 

Excessive perspiration is a trial to many women. 
It makes the hair and scalp oily and greasy, the skin 
coarse, open, and filled with black points or ultimately 
large suppurating pimples ; under the armpits it 
spoils dresses, and both here and on the feel it becomes 
very offensive and irritates the skin ; on the hand- it 
makes them cold and clammy, and in the language of 
a distinguished professor in the Vienna University, 
k 'has often cooled the glow of love." 

Most dermatologists are of the opinion that sup- 
pressing these profuse perspirations by local treatment 
is not followed by any injurious consequences. This La 



FACE, FORM, AND BEAUTY. 335 

doubtless true in many cases, but from personal obser- 
vation the writer is convinced that a sudden check of it 
by harsh local treatment is liable to be followed by very 
unpleasant symptoms. He would earnestly recommend 
for this reason simple remedies and more time in curing 
the case, rather than the use of agents which suddenly 
suppress the secretion. Frequent washing with cold 
water and the frequent change of linen are very neces- 
sary. Bathing every evening with undiluted brandy or 
equal parts of alcohol and water after the water bath, 
and allowing the fluid to dry on the surface, is enough 
to cure some mild cases. Vinegar is excellent for this 
purpose when pure, good, and free from impurities. 
A carefully prepared Standard Vinaigre Cosmetique 
is the best, but if it cannot be obtained, use a teaspoon- 
ful of strong cider vinegar to a quart of cold water. 
Standard Vinaigre Cosmetique used daily has an 
astringent action on the skin, and is a most excellent 
remedy for rough, red blotches, as well as for profuse, 
oily perspiration. Blondes with a fine, sponge-like 
skin prefer it to eau de cologne, which, as a rule, is 
selected by brunettes with a warmer and stronger com- 
plexion. Alcohol and vinegar is a favorite combination 
with many ladies. Never forget to cleanse the skin 
thoroughly with soap and water before applying any of 
these lotions. The above treatment is good for the 
face, armpits, hands, and feet. Powder freely applied 
after the skin is dry absorbs moisture which appears 
later, and is advisable except on the face, where it is 
liable to cause pimples. 

Oily perspiration on the face causes a shining, greasy 
complexion, especially over the nose, which is very 



330 

disagreeable. Wash the face twice a day with juniper 
tar soap, dry it carefully with a soft towel, and use 
either alcohol or vinegar as described above, and if tins 
proves inefficient after a faithful trial, use Standard 
Vienna Cream or Marsh mallow Cream. In smic a 
I have seen excellent results, especially when thee 
were complicated by ivy poisoning, from the use of 
Grindelia robusta 6 *, a dose once in four hours. A cure 
from this remedy is much more satisfactory than from 
any local application. A greasy, oily condition of the 
hair and scalp is best treated by frequenl washing with 
cold water and juniper tar soap, drying the scalp and 
applying once a day with a sponge: — 

H Acid Tannici. • .gr. xvi. 
Spir. v'mi rect. 

Glycerin! aa 1 I. 

A«|. destil 

Perspiration under the arms is successfully in 
by the measures described above. If an ointment Ls 
preferred, the writer can recommend Standard Marsh- 
mallow Cream as an efficient remedy. Wben the 
perspiration is very profuse and powdering the skin 
is not enough to absorb the moisture, muslin sachets 
can be tilled with standard Axillary Sweat Powder and 
worn under the arms. Standard Sweat Powder is good 
to powder freely (^n the skin and inside of the gar- 
ments. The last-mentioned preparation is an invalu- 
able remedy for sweating of the feet. Wash the feet 
every night in cool water, bathe afterwards with 
alcohol or brandy, and then use the powder freely on the 
feet and in the stockings the next day. Always wear a 
fresh, clean pair of cotton stockings each day. and lo 
thin shoes. Never wear woollen stockings, rubbers, or 



FACE, FORM, AXD BEAUTY. 337 

patent-leather shoes. When the perspiration is very 
profuse and the skin is cracked between the toes, fill 
bits of absorbent cotton with the sweat powder and wear 
between the toes and over them. Silicea 5 *, a dose before 
each meal, is very beneficial for offensive sweating of the 
feet and cracking of the skin. Calcaria carb. bx taken 
in the same way when there is profuse sweating of the 
feet and ankles, making the feet feel damp, though 
not offensive or sore. 

Pimples are a source of much annoyance, and are 
often seen only by the young lady herself. In many 
cases constipation, some pelvic disorder, improper diet, 
poor digestion, or a low condition of the system is 
the cause of the trouble, and must be corrected, if need 
be, by the physician. Never confound pimples with 
blotches or red, scurfy spots, as their treatment is quite 
different. Chronic ivy poisoning has produced some of 
the worst cases I have seen. Under such circumstances 
take GrindeJia robnsta (]x before each meal. If the 
pimples are associated with a profuse, oily perspiration 
on the face, it must be cured first as described above. 
Standard Vienna Cream or Marshmallow Cream is an 
excellent remedy for pimples or fine black points in an 
oily skin. A preparation which made a German physi- 
cian famous is the following : — 

R Sulphur precip 3 ii. 

Camphor gr. x. 

Gum mimosas 9i. 

Aquae calcis. 

Aquas rosaf aa § ii. 

Sig. Shake well and apply at bedtime to all that 

portion of the skin affected by large pimples, and the 

next morning rub off all the sulphur adhering to the 

skin without wetting it. 



338 FACE, FORM, AND BEAUTY. 

Before applying the preparation at night, it La a 
good plan to steam the face to bring the pimples to 
a head, and then to press out the yellow points or 
festers with a watch key. Never pick the face or any 
pimples with the fingers; it produces more pimples. 
A simple and effective way of treating coarse, large, 
hard, red pimples, which have lasted for some turn 
to scour them at night with ordinary soft soap and a 
tooth brush : wash the lace the nexl morning with 
Standard Honey Almond Meal, hut do not use water. 

The simplest and in many eases the best wa;. 
treating pimples is to live on very plain food, no pastry, 
no fried or made dishes, no sweet things, pickles, or 
sauces, and take a dose of Sulphur** night and morning. 

The Hair. — The presence of hair on the lace i^ a dis- 
figurement to many ladies, either about the mouth or on 
moles. Coarse hairs can be removed easily by elec- 
trolysis, and are not likely to return. The removal of a 
very large number of hairs requires lime and is apt to 
cost considerable money, hut electrolysis i^ the only 
cient remedy. The various. depilatories and pow< 
advertised are very irritating to the skin. Many of 
them depend on quicklime for their effect, and the hair 
-rows again in a few days coarser than ever. The 
razor is better than any depilatory powder, though 
cutting the hairs always makes them coarse. When 
the hairs are very tine. soft, and light and numerous, 
as on the upper lip, the application of peroxide of 
hydrogen will bleach out the color and make them im- 
perceptible. The hair to he bleached should he washed 
with strong soapsuds, or borax and water, before the 
application of the peroxide of hydrogen. 

Balchtess is usually incurable if of long duration or 



339 

if hereditary. If it is the result of disease, as typhoid 
fever or syphilis, the hair will grow again with the 
return of health without any treatment other than 
ordinary hygienic measures. The excessive use of water 
on the scalp, a sweaty, greasy condition of the scalp, 
the application of glycerine, dandruff, and keeping the 
head lowered are all common causes of baldness. 

The successful treatment of baldness requires that 
it must be commenced in the very beginning of the 
disease. This is seldom done, and not till the hair 
is very thin or the skin bare is the physician consulted ; 
at this stage the hair follicles are often destroyed and 
the case is incurable. The most that can be done then 
is to preserve the remainder of the hair. When the 
hair is very greasy, with yellowish scales in it, the 
same treatment must be used as described above for 
excessive perspiration. The earliest symptoms of bald- 
ness are thin, brittle, dry, lustreless hairs which some- 
times split ; this condition requires prompt attention. 
If the hair is dry, a good pomade made from animal 
fat or pure, unscented oil is a good application ; never 
use vaseline on the hair or any preparations made from 
it : once a month thoroughly rub in the scalp the yolk 
of an egg, and afterwards wash it out with lukewarm 
water ; take special pains to dry carefully the hair after 
washing it ; never wet the scalp if it can be avoided, 
when the hair is dry or dandruff is present. Brush the 
hair very thoroughly with a soft bristle brush night 
and morning ; do not use wire brushes. Combing or 
brushing the hair in the wrong direction, as well as the 
use of curling tongs, is injurious. Pains must be taken 
to improve the general health, and this helps the nutri- 
tion of the hair follicles. Wheat germ meal eaten freely 



340 FACE, FORM, AND BEAUTY. 

every day in some cases will increase the moisture of 
the hair and give it more lustre. Care must be taken. 
when any pomade or oil is applied to the hair, that it 
is sweet and pure. 

When the hair is full of dandruff, there is no better 
cleansing agent than a teaspoonful of a fine quality of 
powdered borax and a quart of lukewarm water, fol- 
lowed by bathing the scalp with pure cold water. Dan- 
druff is made worse by wetting the scalp with water, 
use oil instead. Local applications seldom cure dan- 
druff, but daily prolonged rubbing of the scalp with a 
pure animal Pal improves the circulation and nutrition, 
and cures many cases of dandruff and falling of the 
hair. The fcreatmenl of baldness requires attention to 
hygienic care a- described above. In its early sta 
the most effective treatment would be frequent shaving 
the scalp with a razor for a year and wearing a wig. 
This is not generally practicable, and resorl must he 
had to less efficient treatment. The scalp must be 
cleansed from all grease, crusts, and scales before any 
application is made to it. The egg shampoo or borax 
and water is excellent for this purpose; hut it' the hair 
and scalp are very greasy, soap and water followed by 
clear cold water will he necessary two or three tim< 
week for several weeks. After this apply the following 
ointment, made exactly according to directions, rubbing 
it thoroughly into the scalp with the fingers and brush- 
ing it vigorously afterwards with a stiff bristle brush : — 

H: Pilocarpin mur. 5 —• 

Sulph. praic 5 iii- 

Medull. bovin. 5 Hiss. 

Quia, aiuriat 5 i- 

Bala, pcruvian.. . 5 vi. 
M. s. Hair Pomade. 



FACE, FORM, AND BEAUTY. 3±1 

If the hair is naturally oily, the Standard New York 
Hair Restorer is preferable. These two preparations 
for increasing the growth of the hair are unexcelled, 
and the result of much study and experience of the 
best physicians of two continents. In conclusion the 
author wishes to repeat that the successful treatment 
of baldness requires early and persistent treatment. 
When baldness has been present for some time it is 
scarcely ever cured, as the hair follicles are destroyed. 

Dyeing the hair or whiskers is almost invariably a 
mistake, and once begun must be continued as a rule. 
A natural color of the hair scarcely ever is obtained. 
Many of the dyes contain lead, and will poison the per- 
son using them. The black color produced by nitrate 
of silver is too black to be natural. Other dyes color 
the hair nearly all the tints of the rainbow if not fre- 
quently reapplied, and the writer must strongly advise 
his readers to leave alone all hair dyes. 

Bleaching the hair is produced by moistening the 
hair with the undiluted peroxide of hydrogen. Mar- 
chand's preparation is recommended. This is the 
golden fluid sold for bleaching the hair to a very light 
yellow. 

Lips which have lost the rich color of youth do not 
fully regain it. The color is partially restored in pro- 
portion to gain in health and the rich color of the blood. 
Glycerine usually is harmful to the lips, and ought not 
to touch them. Any preparation in alcohol or even 
water should not be put on sore lips. All lip salves 
must be made from very pure fresh fats. The lips 
should never be bitten or bits of skin pulled off. 
Excoriations or chapping of the lips are readily cured by 



342 FACE, FORM, AXD BEAUTY. 

applying Standard Marsh mallow Cream or Lillien 
Cream. Carmine mixed with the Standard Cold Cream 
can be used to color the lips or to protect them from 
the wind. The imported Blaud's Pills (iron) often 
restore color to white lips by improving the blood. 

A sore in the corner of the mouth with a whitish 
look in the centre is very infect ions and apt to be com- 
municated by kissing. It generally means syphilis. 

/><((/ breath is due to a number of causes which can 

not be detailed here; Chief anion-- them arc neglect 

to brush the teeth and cleanse the month ; decay of 

the teeth ; chrome catarrh ; white curdy deposits on 

the tonsils; a disordered or empty stomach. Proper 

hygiene of the month and good dentistry will cure 

many cases, chronic catarrh and a disordered stomach 

need a physician's care. Peroxide of hydrogen mixed 

with an equal amount of water, and used .1- a gargle 

two or three times a week, is good h>r had breath 

dependent on curdy particles in the tonsils. The 

following prescription is excellent for a month wash : — 

H; Potassii ehlorat... :)ii- 

A«|. destil 5 viii. 

A<|. mepth. pip..- 5 
M. s. Mouth water. 

Standard Tooth and Gum Lotion is the besl remedy if 
the gums are tender, soft, or do not cling tightly to the 
teeth, standard Dentifrice is a sat" and unexcelled 
tootli powder. 

Pastilles de charbon are good to destroy and cure a 
had breath associated with the formation of gas in the 
stomach, though not perfuming the breath like Italian 
mints. 

Hands soft and white are obtained by attention to 



FACE, FORM, AND BEAUTY. 313 

the care of the skin as described in the beginning of the 
chapter. (Compare the subject of fats and excessive 
perspiration.) Rough, chapped hands are often the 
result of very frequent washing, especially if the hands 
are not dried carefully afterward, or if much soap is used 
which is not rinsed off. Many delicate skins will not 
tolerate any water except rain or distilled water. Rus- 
sian egg soap is excellent when it is necessary to use 
soap, and as a rule, Standard Honey Almond Meal should 
be used to cleanse the hands, dispensing with water as 
much as possible, when the skin is so easily irritated by 
it. Standard Vienna Cream or French Cream is excel- 
lent to apply freely on chapped or rough hands. They 
soften the skin, especially the French Cream, and leave 
no grease, so that the most delicate gloves can be worn 
at once without injury. Standard Almond Oil and 
Glycerine is very healing if glycerine agrees with the 
skin, and is an economical preparation, as only a little 
is used at a time. 

A simple domestic remedy for chapped hands which 
is often successful is to mix four tablespoonfuls of 
Indian meal and a little salt in a quart of water ; 
wash the hands thoroughly once a day in this mixture 
without using soap ; dry them carefully and wear snug 
but not tight-fitting gloves. Standard Vienna Cream 
is good for sweaty hands. Sunburned hands are best 
treated in the same way as sunburn and tan. Standard 
Emollient is an excellent cream to make the hands 
white and soft. It is to be applied freely at night, and 
gloves worn over the hands both night and day. It 
is not so well adapted to clay use, as it leaves the skin 
a little greasy as after using vaseline. 



344 FACE, FORM, AND BEAUTY. 

TJie nails are often spoiled by lack of proper care. 
The beauty of the nail is marked by good proportion, 
smoothness, translucency, gloss, and an even pinkish 
color with a regular white crescent at its base. The 
free border should extend to the finger tip and not much 
beyond. The nails should not be bitten, cut close to 
the quick, or the nail cleaner pressed back to sepaj 
the nail from the flesh. The nails are best cleaned 
with a dull instrument, and cut with a sharp one, but 
not much at the corners, as it will cause ingrowing 
nails. Keep the line of white skin at the root of the 
nail evenly pushed back with a piece of smooth ivory. 
The white spots in the nail are due to an anomalous 
secretion of the corium, and all remedies arc useless 
for it, though covering the nail with wax sometimes 
hastens their disappearance. A nail which has 1 

rely bruised often becomes missha pen and sometimes 
conies off. The new nail growing after it is nol so tine 
in color, but if it is kept covered with white wax during 
the period of growth it will be much improved. Tin- 
nails often become brittle with advancing years. 

Little pieces of loose skin about the nails arc termed 
in common parlance hangnails. These must not be 
pulled off. but cut off close to the skin. When \ 
numerous and persistent, and also if the nails are bril 
a dose of Silicea** night and morning will improve the 
nutrition of the skin and in this way cure the hang- 
nails. The application of Standard Marshmallow 
Cream is also beneficial. Do not scrape the nails 
unless for some special purpose, as in treating ingrowing 
nails. Lemon juice applied to the surface only iA' the 
nail is an excellent polishing agent, but it is liable 



FACE, FORM, AND BEAUTY. 345 

to pucker the surrounding skin if it touches it. Rapid 
growth of the nails is a good indication that the body 
is well nourished. Standard Nail Powder is the best 
polishing and tinting powder which the author has 
seen. It is soft and delicate, and gives a fine polish 
without injuring the nail. 

Ingrowing nails are common on the feet, and with a 
little patience are easily remedied. Wash and dry the 
feet every night ; cut the nail squarely across ; do not 
cut out the corners, but let them grow out ; scrape the 
nail on top close to the quick, and then by the aid of a 
little absorbent cotton turn out the corners from the 
sore places and press under the edges of the nail a little 
cotton. Wear loose shoes with plenty of room for the 
toes during this treatment. If the edge of the nail has 
caused a raw. sore, festering place, a portion of the 
margin of the nail must be removed, but the cure of 
the case will depend on three things, cutting the nail 
squarely across, leaving the corners to grow beyond the 
skin : scraping thin the top of the nail along the centre ; 
and wearing shoes with plenty of room for the toes. 

Corns are a common annoyance, and must be ex- 
pected by those who wear too tight shoes. Corn 
plasters may give temporary relief, but often aggravate 
the case in time. The following treatment will do 
good. Wear properly fitting shoes ; soak the feet at 
night in hot water ; remove the horny top and point of 
ingrowing hard tissue at night, if convenient, with an 
ordinary sharp knife, and apply the following prescrip- 
tion to the corn only. After a few applications the 
corn is easily picked out. The effect is the same ulti- 
mately if the corn is not cut. Cutting merely saves time. 



346 FACE, FORM, AND BEAUTY. 

R Acid. Salicyl., 5j- 
Alcoh. absol., 3v. 
M. s. Apply with a brash. 

In concluding this subject, the author desires once 

more to remark that good health is the basis of good 

looks, and the surest means of preserving beauty. Art 

may do much to assist nature, but she can hardly 

improve upon her. Good health, good hygiene, and 

good sense arc essential to those who wish to make the 

most of nature's gifts. 



I in is. 



INDEX 



PA6E 

Abdomen, size of, in pregnancy . . 198 

Abortion 220 

Abortion, law for committing . . . 2-21 

Abscess of the breast 287 

Abscess of the vulya SO 

JEther in childbirth 26S 

Afterpains .... 280 

Alcohol lor the toilet 318 

use of 322 

Amenorrhea 94 

Ammonia for the toilet 318 

Anatomy 24 

Anus 24 

Arrowroot, preparation of .... 308 

Artificial food 301 

Atresia of the vagina 91 

Babies prematurely born .... 310 

Baby basket 229 

blankets 229 

care of new-born 291 

powder 296 

weighing the 303 

Baby's first clothes 231 

Baldness 339 

Barley water, preparation of . . . 307 

Basket for baby 229 

Bath, the first 291 

Bathing a baby 292 

Bathing for the complexion . . . . 319 

Bath tub, folding 294 

Bay rum for the toilet 318 

Beauty 312 

Bellybamls 237,296 

Birthmarks 210,334 

Bladder, anatomy of the 28 

Blood, absent at time of period . . 94 

excessive at time of monthly . 104 
periodica] loss from unusual 

places 112 

poisoning 289 

scanty at time of period . . . 1"4 

Boil- on genitals 80 

Breast, abscess of 287 

caked .... 285 

Breasts, care of the 282 

toughening of 207 



PAGE 

Breath, bad odor of 342 

Bust, how to develop 317 

Caked breast 285 

Cancer 188 

and leucorrhcea 150 

Cauls 253 

Causes of women's diseases .... 40 

dialing 310 

Change of life 43 

hygiene of the 50 

peculiarities of the 69 

treatment at the 70 

tumors of . 182 

Childbearing and dysmenorrhea . 116 

Childbed fever 289 

Child, viability of ........ 220 

Chlorosis 52 

treatment of 54 

Clap 82, 150 

Climacteric, hygiene of the .... 50 

peculiarities of the 69 

period 43 

treatment at the 70 

Clothing at night 239 

first for baby 231 

Complexion 312 

how to acquire 314 

powders 328 

Conception 195 

Congestion of the uterus 149 

Constipation 219 

in lying-in period • 276 

Constitutional symptoms 11 

Consumption in pregnancy .... 225 

of the blood 52 

Convulsions, premonitory symptoms 225 

Cord, care of the 262 

dressing of the 295 

Corns 345 

Corsets 314 

Cosmetics 312, 323 

Crab louse 73 

Cy-tocele 78 

Dandruff 339 

Deafne-s during period 69 



34S 



INDEX. 



Decimal scale for medicine- 
Delivery, date of 

Diet for lying-in .... 



PAGE 
16 

. 198 

.. 270 

in pregnane}- 203 

Dilution of drugs 17 

Disinfection of a room 242 

Disks, dose of 16 

Dose of disks 16 

of pills 16 

of powder 16 

of tablets 16 

Douche, hot- water vaginal .... it 

Douches, medicated 49 

Dysmenorrheas 114 

Eczema <>i the vulva 74 

Education, effect on menses ... ;h; 

Electricity for painful menstruation lis 

for uterine displacements • II" 

Epithelioma 188 

Erosion of the cen i\ uteri . . . 149 

Eruptions <>n the vulva 7» 

Examination, rule for 

\v' 10 

Eyebrows 

Face 811 

powders 896 

Falling of the womb 180 

Pats, use of i 

Feet, sweating of 

Fibroid tumors l^ 11 

Fibroids, remedies for 184 

Figure 819 

Fistula 84, 88 

Flannel, washing of 

Food, amount for feeding . . . 
disagreement <>f . . 

the hes' artificial 804 

when to give solid 809 

Foot hatha 49 

Fool bath, hot 117 

Form ::1J 

Freckle- 880 

Fumigation of a room 949 

Gertrude suit 289 

Glycerine 3-2-2 

Gonorrhoea 89, 160 

Green sickness 62 

Gymnasium for ladies 317 

Hair, arrangement for confinement 247 

bleaching of 888 

dyeing of 341 

oily 886 

on face .'lis 

Hands, application of ointment on . 321 



Hand-, chapping of 

soft and white 

Hangnail- 

Headache attending the period . ;,; 

Head, misshapen -jm 

Heart disease in pregnancy . . 

Heartburn -_>i;» 

Hemorrhage after childbirth . . 

Hip baths 

Dot loot hath H7 

Hot-water douche 47 

ae of puberty 

Hymen 

1 11: 

Incubators .;n 

Inflammation of the ovaries 

Of tin- uterus 

ot the vagina 

u Ing nails .... 

instruments, where to buy . . . 21 

Itching oi the genitals 

Ivy poisoning 

Knee-chest position 

Knit good- 

Kuiuyss J14 

Labia 94 

Labor 

article- Deeded in . , 

pain-, false and true . . . 

preparation tor 94] 

ol 

ation Of the cen i\ Uteri . . . 149 

of the perineum 

Leucorrhoea 149 

and cancer 159 

in girls 

Lice on the genitals ...... 

Lime water, preparation of . . . 191 

Lips - 

Liver spots 

Lochia 

Lying-in period 

Malignant tumors 

Marriage, and tumors, cancer, con- 
sumption, or insanity ... 

and uterine disease 

1 cure for female diseases ■ . 116 

of near relatives 

Maternal impressions affecting child 211 

Mature infants, sign- of 991 

Medical instead of surgical treat- 
ment 13 

Medicine, changing of U 

frequency of giving IB 



INDEX. 



349 



tii- 



Medicine. how to mix in water 
Medicine-, most important 

where to purchase . . 
Membrane with the monthly 
Menorrhagia . . 
Menstrual headache 

napkins . . 

period, symptom of the 

toothache .... 
Menstruation .... 

excessive .... 

painful 

scanty or absent . . 

vicarious .... 

Metritis 

Milk, analysis of . . . 

apparatus for sterilizi 

leg 

sterilizing .... 

tests for good*. . . 

to increase secretion 

to stop its secretion 
Miscarriage 

causes and symptoms 
Monthlies, profuse flowin 
Monthly, absence of the 

flow 

flow and education 
Mouth, nursing sore 
Myomas 

remedies for . . 

symptoms of . . 



Of 



PAOB 

17 

14 

22 

115 

104 

57 

47 

51 

. G4 

42 

104 

114 

94 

211 

15S 

301 

306 

289 

303 

301 

2SS 

2S6 

i, 220 

223 

104 

94 

42 

96 

311 

180 

184 

181 



N»vi 334 

Nails, ingrowing of 345 

Napkins 47 

Nausea and vomiting of pregnancy . 213 

during 213 

Navel, dressing of the 295 

Neck, scrawny 317 

Neuralgia of ovaries 175 

New-born babe, care of 291 

Nipples, soreness of the 284 

Nurse, engaging a 247 

Nursing, diet for women 300 

hours for 298 

the baby 283 

rules for 299 

signs of healthy 297 

sore mouth 311 

when not to nurse 297 

Oatmeal water, preparation of . . 308 

Oily perspiration :;:;.-; 

Operation on the perineum .... 79 

Ovarian neuralgia 175 

tumors 181. 185 

Ovaries, neuralgia of ..... . 175 



PAGS 

' Ovaritis, inflammation of HIS 

treatment of 170 

Ovulation 197 

Ovum 29, 195 



Paralysis of face after delivery . . 291 

Physicians, consulting by mail . . 17 

selection of , . . 17 

Piles . 25, 276 

Pills, dose of 16 

how to medicate 16 

Pimples ; .... 337 

Pinworms 75 

Pediculus pubis 73 

Pelvic cellulitis 158 

peritonitis 15s 

Pelvis, deformity of . 25 

false . . . . . . 25 

true 25 

Perineum 26 

laceration of 78 

Peritoneum 28 

Peritonitis 29 

Perspiration, excessive 334 

under the arms 336 

Polypus 180 

Pomades 320 

Powder, dose of 16 

Pregnancy and toothache .... 68 

calculation of 198 

care of breasts 207 

conditions of blood 206 

consumption in 225 

decay of teeth during . ... 206 

diseases of 213 

dress during 207 

duration of 198 

heart disease in 225 

hygiene of 203 

itching of the genitals .... 220 

longings during 206 

nervousness during 212 

signs of 199 

unlawful 222 

Premature labor 220 

Prenatal influence 212 

Prescribing, selection of symptoms 

for 13 

Prickly heat 332 

Prolapsus uteri 130 

Pruritus vulva- 73 

Puberty 41 

Puerperal fever 289 

period 2"0 

Rectocele 78 

Rectum 24 

Replacing the uterus ...... 136 






350 



Salivation 

Salpingitis 

Scaly spots 

Self-conception 

Septicaemia 

Sex, production of, at will . 

Short clothes 

Silz baths 

skin, balsams for 

chafing or soreness of the 
color of the ..... 
excessive perspiration on 
rough, dry, dull .... 

stimulation of 

wines for 

skinny pieces with the month! 

Soap : 



INDEX. 



PAGE 

. 217 
181, 186 

197 

209 

240 
49 



321 



310 
316 

115 

319 



Soothing syrups 

Sore nipples 

Spa«m of the vagina 

Spermatozoa ' 1911 

Standing Btool 241 

Sterility and dyimenorrhoaa • • • 116 
and uterine displacement . ■ . i-T 
Stomach, ulceration of the . , . 
Supporter, how to make an abdo 

n.il 184 

Sweating of the bead .... 
Symptom*, value of different . . . 10 

Tablet, .... . . . 16 

Tan, sunburn 

Thenails 

Therapeutics of ovarian neuralgia • 1 77 

Toothache 817 

during pregnancy 

during the period . . 84 

Tumors 180 

at the change ol life 182 



symptoms <>i' 

treatment by electricity . 



Ulceration of the cervix uteri . . . 

Unfortunate girls 

Urethra 

Uterine ligaments strengthened by 

an exercise 

Uterus 

forward displacements of . . . 

how to replace 

jtertor displacements of the . 
probabilities of curing dls] 

ments of the 

treatment of displacements ol 
the 



r-AGB 
148 



138 

27 

i.;i 
185 
144 



- 



: 

complete or part 

the 

-|>a-m of the ■ • 

lismUS .... 

nltls 

Viability of the child . . 
Vinegar for the toilet . . 

lost during the period 
Vomiting during pregnancy 
Vulva . . . . • . . • • 



1 closure of 



Walk, how to 

Warts 

Washing povi der , , 

Water lor the t..: 

Weaning 

w eight, rate ol gain In 
Wet nurses ....... 

Whiskey tor the toilet 

Whit— 

Womb, anatomy of the 

W'ollr 

Worm- 

Wrinkle- , . , 



81 

89 

24 



■01 

148 



Yellow spots 






